REPORT NO. 70

PARLIAMENT OF RAJYA SABHA

DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE

SEVENTIETH REPORT Demands for Grants 2013-14 (Demand No. 50) of the Department of AIDS Control (Ministry of Health and Family Welfare)

(Presented to the Rajya Sabha on 26th April, 2013) (Laid on the Table of on 26th April, 2013)

Rajya Sabha Secretariat, New Delhi April, 2013/Vaisakha, 1935 (Saka) Website:http://rajyasabha.nic.in E-mail:[email protected] 27 Hindi version of this publication is also available

PARLIAMENT OF INDIA RAJYA SABHA

DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HEALTH AND FAMILY WELFARE

SEVENTIETH REPORT

Demands for Grants 2013-14 (Demand No. 50) of the Department of AIDS Control (Ministry of Health and Family Welfare)

(Presented to the Rajya Sabha on 26th April, 2013) (Laid on the table of Lok Sabha on 26th April, 2013)

Rajya Sabha Secretariat, New Delhi April, 2013/Vaisakha, 1935 (Saka)

CONTENTS

PAGES

1. COMPOSITION OF THE COMMITTEE ...... (i)-(ii)

2. PREFACE ...... (iii)-(iv)

3. ACRONYMS ...... (v)-(vi)

4. REPORT ...... 1—15

5. OBSERVATIONS/RECOMMENDATIONS — AT A GLANCE ...... 16—20

6. MINUTES ...... 21—26

COMPOSITION OF THE COMMITTEE (2012-13)

RAJYA SABHA 1. Shri Brajesh Pathak — Chairman 2. Dr. Vijaylaxmi Sadho *3. Dr. K. Chiranjeevi 4. Shri Rasheed Masood 5. Dr. Prabhakar Kore 6. Shri Jagat Prakash Nadda 7. Shri Arvind Kumar Singh 8. Shri D. Raja 9. Shri H. K. Dua 10. Shrimati B. Jayashree

LOK SABHA @11. Shri Ashok Argal 12. Shri Kirti Azad 13. Shri Mohd. Azharuddin 14. Shrimati Sarika Devendra Singh Baghel 15. Shri Kuvarjibhai M. Bavalia 16. Shrimati Priya Dutt 17. Dr. Sucharu Ranjan Haldar 18. Mohd. Asrarul Haque 19. Dr. Monazir Hassan 20. Dr. Sanjay Jaiswal 21. Dr. 22. Shri Mahabal Mishra 23. Shri Zafar Ali Naqvi 24. Shrimati Jayshreeben Patel 25. Shri Harin Pathak 26. Shri Ramkishun 27. Dr. 28. Dr. Arvind Kumar Sharma 29. Dr. Raghuvansh Prasad Singh 30. Shri P.T. Thomas #31. Shri Chowdhury Mohan Jatua

* Ceased to be Member of the Committee w.e.f. 28th October, 2012. @ Ceased to be Member of the Committee w.e.f. 9th January, 2013. # Nominated as a Member to the Committee w.e.f. 14th December, 2012.

(i) (ii)

SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R.B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director Shri Pratap Shenoy, Committee Officer PREFACE

I, the Chairman of the Department-related Parliamentary Standing Committee on Health and Family Welfare, having been authorized by the Committee to present the Report on its behalf, do hereby present this Seventieth Report of the Committee on the Demand for Grants (Demand No. 50) of the Department of AIDS Control, Ministry of Health and Family Welfare, for the year 2013-14.

2. The Committee held one sitting, on 5th April, 2013 for examination of Demands for Grants (2013-14) of the Department of AIDS Control and heard the Secretary (AIDS Control) and other officers thereon.

3. The Committee while making its observations/recommendations has mainly relied upon the following documents:–

(i) Address by the President of India to both Houses of Parliament assembled together on 21st February, 2013;

(ii) Speech of Finance Minister on 28th February, 2013 while presenting the Union Budget 2013-14;

(iii) Implementation of Budget Announcements 2012-13;

(iv) Detailed Demands for Grants of the Department of AIDS Control for the year 2013-14;

(v) Annual Report of the Department for the year 2012-13;

(vi) Outcome Budget of the Department for the year 2013-14;

(vii) Detailed Explanatory Note on Demands for Grants of the Department of AIDS Control for the year 2013-14;

(viii) Physical and financial targets fixed and achievements made during the Eleventh Plan period;

(ix) Projection of outlays for the schemes to be undertaken by the Department during the Twelfth Five Year Plan;

(x) Details of under-utilization of the allocations made under different heads during the last three years;

(xi) Written replies furnished by the Department to the Questionnaires sent to them by the Secretariat;

(xii) Presentation made by the Secretary (AIDS Control) and other concerned officers; and

(xiii) Written clarifications furnished by the Department, on the points/issues raised by the Members during the deliberations of the Committee.

(iii) (iv)

4. The Committee considered the Draft Report and adopted the same in its meeting held on 23rd April, 2013.

5. For facility of reference and convenience, observations and recommendations of the Committee have been printed in bold letters in the body of the Report.

BRAJESH PATHAK NEW DELHI; Chairman, 23rd April, 2013 Department-related Parliamentary Standing Vaishakha 3, 1935 (Saka) Committee on Health and Family Welfare ACRONYMS

AEP – Adolescence Education Programme AIDS – Acquired Immuno-Deficiency Syndrome ANC – Ante-natal Clinic ART – Antiretroviral therapy BPL – Below Poverty Line ARV – Anti-retro-viral BCSUs – Blood Component Separation Units CBO – Community-Based Organisation CoEs – Centres of Excellence CLHIV – Children living with HIV/AIDS CABA – Children affected with AIDS CPFMS – Computerized Project Financial Management System DAC – Department of AIDS Control DLBB – District Level Blood Banks DAPCUs – District AIDS Prevention and Control Units EFC – Expenditure Finance Committee FSW – Female Sex Worker FHI – Family Health International GFATM – Global Fund of AIDS, Tuberculosis and Malaria GIPA – Greater Involvement of People Living with HIV/AIDS LCHAU – Lawyers Collective’s HIV/AIDS Unit NACP – National AIDS Control Programme NACO – National AIDS Control Organisation HBV – Hepatitis B Virus HCV – Hepatitis C Virus HIV – Human Immunodeficiency Virus HRG – High Risk Group ICTC – Integrated Counseling and Testing Centre IEC – Information, Education and Communication

(v) (vi)

IDU – Injecting Drug User ICMR – Indian Council of Medical Research NBTA – National Blood Transfusion Authority NCERT – National Council of Educational Research and Training MSM – Men having sex with Men NGO – Non-Government Organisation NRHM – National Rural Health Mission OST – Opioid Substitution Therapy PLHIV – People Living with HIV PPTCT – Prevention of Parent to Child Transmission RTI – Reproductive Tract Infection RREP – Red Ribbon Express Project RRE – Red Ribbon Express SACS – State AIDS Control Society STRC – State Training and Resource Centre STI – Sexually Transmitted Infection TI – Targeted Interventions TG – Trans-genders TB – Tuberculosis TSUs – Technical Support Units UNICEF – United Nations Children’s Fund USAID – United States Agency for International Development WHO – World Health Organisation 1

REPORT

I. INTRODUCTION

1.1 As per information furnished by the Department of AIDS Control, India has the third highest number of estimated people living with HIV/AIDS, after South Africa and Nigeria (UNAIDS Report on the Global AIDS epidemic, 2010). According, to the HIV Estimations 2012, the estimated number of people living with HIV/AIDS in India was 20.89 lakh with an adult prevalence of 0.27% in 2011. HIV epidemic in India is concentrated among High Risk Groups and heterogeneous in its distribution.

1.2 As per information received from the Department, its main objective envisions preventing and reducing HIV burden in India. The NACP Phase-I (1992-99), Phase–II (1999-2006) and Phase– III (2007-12) was initiated by the National AIDS Control Organization (NACO). During the NACP phase-III, the Department of AIDS Control was made as a separate department under the Ministry of Health and Family Welfare. The mission is to reduce HIV prevalence in population groups at risk of HIV/AIDS thorough an integrated prevention, care and support programme.

1.3 To achieve this, the National AIDS Control Programme (NACP) is being implemented as a comprehensive programme for prevention and control of HIV /AIDS in India since 1992 when it was launched with support from the World Bank. With improved understanding of the complex HIV epidemic in India, substantial changes have been made in the policy frameworks and approaches of NACP. The focus has shifted from raising awareness to behavior change, from a national response to a more decentralized response and to increasing involvement of NGOs and network of PLHIVs.

1.4 The Department has further informed that an analysis of targets done at the time of mid- term review and subsequent joint implementation review mission has revealed that most of the targets have been achieved or will be achieved shortly. Results of the epidemiological models and programme data (surveillance ANC, HRG population, and ICTC) shows that the target of halting the epidemic has been achieved and reversal process has been initiated at the national level during this time frame. Adult HIV prevalence at national level has declined from 0.41% in 2001 through 0.35% in 2006 to 0.27% in 2011. India has demonstrated an overall reduction of 57% in estimated annual new HIV infections (among adult population) during the last decade from 2.74% lakhs in 2000 to 1.16 Lakhs in 2011. Wider access to ART has led to 29% reduction in estimated annual AIDS-related deaths during NACP–III period (2007-11). India is committed to achieving Millennium Development Goals. Keeping this in view, the primary goal of National AIDS Control Programme–IV is to accelerate the process of reversal and further strengthen the epidemic response in India through a cautious and well-defined integration process over the next 5 Years.

1.5 Towards this end, the National AIDS Control Programme Phase-IV has been introduced with the aim to accelerate the process of reversal and further strengthen the epidemic response in India through a cautious and well-defined integration process over the next 5 years, i.e., 2012-17. The Secretary, Department of AIDS Control, during the course of his deposition, apprised the Committee of the following initiatives proposed in NACP–IV:

(a) Pronged Strategy for NACP-IV

· Intensifying and consolidating, prevention services with a focus on (a)high-risk groups and vulnerable population and (b) general population; 2

· Expanding IEC services for (a) general population and (b) high-risk groups with a focus on behavior change and demand generation; · Increasing access and promoting comprehensive care, support and treatment; · Building capacities at national, State, district and facility levels; · Strengthening Strategic Information Management Systems.

(b) Key priorities under NACP IV · Preventing new infections by sustaining the reach of current interventions and effectively addressing emerging epidemics; · Prevention of Parent to Child transmission; · Focusing on IEC strategies for behaviour change in HRG, awareness, among general population and demand generation for HIV services; · Providing comprehensive care, support and treatment to eligible PLHIV; · Reducing stigma and discrimination through greater involvement of people living with HIV(GIPA); · Ensuring effective use of strategic information at all levels of programme; · Building capacities of NGO and civil society partners especially in States of emerging epidemics; · Integrating HIV services with health systems in a phased manner; · Mainstreaming of HIV/AIDS activities with all key Central/State level Ministries/ departments will be given a high priority and resources of the respective departments will be leveraged. Social protection and insurance mechanisms will be leveraged.

(c) Key Initiatives in Care, Support and Treatment · Phasing out Stavudine based regimen: – Was part of national programme for patients who are anemic. – WHO recommendation to phase out in view of its long term side effects. – Phase out initiated in India from June, 2012 (No new patients being given Stavudine) – All existing patients are being shifted to Tenofovir – to be completed by April, 2013 · Universal access to second line ART: – Second line ART introduced in January, 2008 at 2 Centres of Excellence (CoEs) – Expanded to the all 17 COEs and 24 upgraded ART Plus Centres – Initially, provided free only to widows, children and BPL patients – Made available free to all those who require it, since 2010

II. Budgetary Allocation 2.1 As per information given in the Background Material, an amount of Rs. 15,815 crore was projected to the Planning Commission as Twelfth Five Year Plan Outlay (2012-17) for National AIDS Control Programme Phase–IV. However, Planning Commission has approved an outlay of Rs. 11394.00 for the Twelfth Plan as budgetary support. 3

2.2 The Planning Commission has been requested to revise the project cost of NACP-IV to Rs.15,815.00 crore, keeping in view the future support from Global Fund and extra budgetary supports from the other development Partners. The Department has further informed that in view of EFC’s approval for World Bank assisted project and revision of EFC for 4 metro Blood Banks, the project cost of NACP–IV is being reworked and likely project cost would be of the order of Rs.15724.00 crore. 2.3 The Committee observes that the 1st year of the Twelfth Plan Period has already elapsed and the 2nd Year is in progress. However, the Department is still in the process of reworking the project cost of NACP–IV for the Twelfth Plan period. The Committee observes that the delay of more than a year in finalization of the project cost of such a critical programme like NACP-IV is a sad commentary on the working of the Department and calls for urgent remedial measures. The Committee feels that the delay will have an adverse impact on the intended outcomes of NACP-IV unless timely action taken. In an era of e-governance and with IT resources currently available, the Department should have finalized the project cost long back. The Committee, therefore, deprecates the delay in this regard and desires to be apprised of the reasons for the same. The Committee recommends that the Department should finalize the project cost at the earliest and in such a manner so that the intended outcomes of this programme are not adversely affected. The Committee may be apprised of the progress made in this regard. 2.4 The Committee has been informed that against a projection of Rs.2770.00 crore by the Department of AIDS Control, a plan outlay of Rs.1785.00 crore has been allocated by the Planning Commission for the year 2013-14. The Department has informed that the components of the Plan likely to be affected due to shortfall include blood safety, IEC, supply of condoms, contribution for Global Fund, Care, Support and Treatment and ICTC/PPTCT. It is Government’s endeavour to ensure implementation of the programme with funds allocated. However, if enhancement of provision is required during the course of the year, it will be obtained through supplementary demands for grants. 2.5 The Committee observes that in a resource constrained country like India, the efficient deployment of the available resources is the key for success of any programe/ scheme. The Committee, therefore, recommends that the Department should initiate concrete measures for efficient use of the allocated funds and remove apparent inefficiencies at every level of programme implementation. 2.6 The Secretary, Department of AIDS Control, during the course of his deposition before the Committee on 5th April, 2013 informed the Committee that the BE, RE and expenditure figure for 2010-11, 2011-12 and 2012-13 are as follows:– (Rs. in crore) Year Budget Revised Expenditure % Budget Estimates Estimate Incurred Utilization 2010-11 1435.00 1400.22 1167.21 83.36% 2011-12 1700.00 1500.00 1313.86 87.59% 2012-13 1700.00 1759.56 1345.16* 76.45% 2.7 On the reasons for downward revision at the RE stage, the Secretary informed that saving occurred due to delayed implementation of programme/activities in some of the States. Releases were also made to the SACS taking into consideration the balances available with States. Savings was also due to delay in procurement process, less expenditure incurred on State Training and Resource Centre (STRC)/Technical Support Unit (TSUs) which conducts training of staff and provides technical experts to the implementing agencies and funds allocated for planned procurement could not be fully utilized due to inability of the procurement agent to complete planned procurement on schedule. 4

2.8 The Budgetary allocation made in 2012-13 was Rs.1700.00 crore which was increased to Rs.1759.56 crore at RE stage with expenditure of Rs.1345.16 crore. Explaining the reasons for enhancement in RE stage, the Secretary informed that the main reason for enhancement of plan allocation during the year was on account of procurement of drugs and consumables required for free treatment of People Living with HIV/AIDS (PLHA). The enhanced allocation for the year was not fully utlised during the year as savings occurred due to shortfall in certain expenditures relates to North Eastern States and procurements mainly related to ARV drugs, tests kits and blood bags not materializing.

2.9 The Committee expresses its serious concern that the actual expenditure of the Department for the year 2010-11 was Rs.1167.21 crore as against the BE of Rs.1435.00 crore; for the year 2011-12, Rs.1313.86 crore as against BE of Rs.1700.00 crore, and for the year 2012-13, Rs.1345.16 crore as against BE of Rs.1700.00 crore. The Committee expresses its disappointment at this persistent trend of under-utilization of the budgeted funds and is of the view that this trend is not only indicative of fiscal indiscipline but also points to slack monitoring of utilization of the sanctioned provisions. The Committee feels that the reasons adduced by the Department cannot justify shortfall in expenditure to the tune of Rs.267.79 crore in 2010-11, Rs.386.14 crore in 2011-12 and Rs.354.84 crore in 2012-13. The Committee, therefore, recommends that the Department should put in place a strict and effective monitoring mechanism to ensure that the funds allocated to the Department are monitored quarterly, and exercise utmost fiscal prudence and discipline so as to make realistic Budget Estimates in future. The Committee desires to be apprised of the measures initiated in this regard.

2.10 Regulation of release of funds to the State AIDS Control Societies due to availability of considerable balances with them has been cited as the main reasons for the savings. On a specific query in this regard, the Department has informed that the opening balance amounting to Rs.206.32 crore was available with SACS as on 1st April, 2012, which increased to Rs. 290.23 crore as in the opening balance at the beginning of 2013-14. A comparative analysis of State wise figures during 2011-12 and 2012-13 indicates that the status regarding the main defaulter States remained unchanged. Following details are self explanatory:– (Rs. in crore) SACS 2011-12 2012-13 Balances as on Opening Balance Opening Balance 28.02.13 Andhra Pradesh SACS 15.45 7.24 23.33 Bihar SACS 6.16 8.29 18.22 Delhi SACS 8.54 1.41 7.81 SACS 9.75 8.70 14.58 Karnataka SACS 19.20 14.83 26.60 Madhya Pradesh SACS 13.98 16.09 22.22 Maharashtra SACS 19.81 12.40 18.61 Rajasthan SACS 7.33 7.89 3.33 Tamil Nadu SACS 7.51 6.14 27.91 SACS 13.04 15.17 3.35 5

2.11 The Department has stated that the following concrete steps are being taken to ensure optimum utilization of funds:– (i) Alignment of Budget with project goals and prioritization of activities. (ii) E-payment of salaries to staff of peripheral units like, Anti Retroviral Treatment (ART) Centers, Integrated Counseling and Testing Centers (ICTC), Blood Banks, Sexually Transmitted Infection (STI) Clinics has been implemented by SACS. This has helped to reduce the substantial amount of advances that were earlier being extended for this purpose and pace of utilization has improved significantly. (iii) Monitoring of resource utilization by SACS is conducted through a computerized Project Finance Management System (CPFMS). (iv) Releases to States are being done through e-transfer to reduce transit delay. (v) Improvement in Staffing and Capacity Building. (vi) DAC has taken steps to ensure implementation of systems and procedure for regular periodic adjustment of advances as opposed to one-time special efforts for clearing advances being made hitherto. (vii) Systems have been established to release the sanctioned amount in phased manner and to closely monitor the cash flow to peripheral units so that the states, at no point, face shortage of resources. (viii) Monitoring is done through on line systems by having a snap shot of the resource position at any given point of time. (ix) Review of various components of the programme implementation in the States is taken with all the SACS. 2.12 The Committee appreciates that due to the efforts made by the Department, there has been a considerable decline in unspent balances available with the SACS. The Committee would, however, like to point out that availability of unspent balance with some SACS, like Andhra Pradesh SACS (Rs.23.33 crore), Bihar SACS (Rs.18.23 crore), Gujarat SACS (Rs.14.58 crore), Karnataka SACS (Rs.26.60 crore) is still quite high. The Committee emphasizes that the Department should make concerted efforts to get resolved all the unspent balances with the societies so that funds do not accumulate and remain unutilized. The Committee recommends that in order to ensure timely and effective utilization of unspent balances, the Department should insist on quarterly feedback from all the State AIDS Control Societies. Close monitoring of their activities and spending will certainly deliver the desired results. 2.13 It has been informed that the allocation for grants to SACS in BE 2013-14 has been proposed at Rs.833.00 crore keeping in mind the level of activities proposed for this year. The Committee was also informed that during 2013-14, the increased cost is due to the setting up of new targeted interventions to cover the HRG (High risk groups) populations in hitherto uncovered areas and transitioning of TI projects from Development partners into the national programme and 300 new TI projects (including source/transit migrant intervention) and 80 new Opioid Substitution Therapy (OST) centres would be set up in the year. 2.14 The Committee takes note of the submission that the increased grants to SACS is due, transitioning of Targeted Intervention (TI) projects from Development Partners into the national programme. The Committee observes that funding from Development Partners have played a vital role in supporting the NACP programme interventions in the past. The 6

Committee would, therefore, like to be apprised of the reasons behind shifting the TI projects from Development Partners to the national programme and its implication on funding of HIV programmes in the Country.

III. Role of NGOs. 3.1 The Committee understands that Targeted Interventions are preventive interventions working with high risk groups in defined geographic area. Target Intervention Projects (TIs), implemented by NGOs/Community Based Organization (CBOs) work with both core HRGs (Female Sex Worker (FSW), Men having sex with Men (MSM), Transgenders (TG) and Injecting Drug Users (IDU) as well as Bridge population and provide preventive interventions through a peer led approach. As per the information provided by the Department regarding updated status of the discontinued NGOs, the Committee has been apprised that out of the total outstandings from NGOs amounting to Rs.352.17 lakhs in 27 States, an amount of Rs. 251.8 lakhs has been recovered which is 71%. NGOs in 11 States have a balance of Rs.100.8 lakhs still to be recovered from terminated NGOs as on January, 2013. Action has been initiated with respect to recovery of the unspent balances amount from NGOs/CBOs and against those NGOs which do not comply, necessary legal action is taken by involving the district Collector or Commissioner. 3.2 The Committee expresses its displeasure over the issue of non-recovery of unspent balances from the NGOs by the Department, even after about two years. Out of 27 States, 11 States have a balance of Rs.100.8 lakhs still to be recovered. The Committee recommends that the issues like contract norms fixed for NGOs-State-wise, the reasons for delay in recovering the same along with the details of action taken against the NGOs who have repeatedly defaulted in paying back the unspent balances. In future, funds should be released only to such agencies which have the capacity to utilize the allocated amount.

IV. Setting up of new Blood Component Separation Units (BCSUs) 4.1 The Department has informed that in order to promote rational use of blood, 82 BCSUs were established during the first two phases of NACP through installation of essential equipment, manpower and consumable support. At present, there are 175 NACO supported BCSUs with the license for operating as component separation units. These BCSUs have started working in their respective States and the proportion of blood units processed for component separation has risen from 47% to 51% in the financial year 2012-13, till December, 2012. Quality management modules were prepared by Technical Resource Group to increase Blood Component separation in the BCSUs. 4.2 The Committee, in its 57th Report presented to Rajya Sabha on 26th April, 2012, had commented about addressing the issue of quality of blood banks. The Department, in its Action Taken Notes, has informed that NACO is focusing on quality management systems in Blood Banks and efforts are being made to monitor the blood banks and core Committees have been constituted in all states to monitor all blood banks. 4.3 The Committee is not aware as to what headway has been made towards concretizing the above proposal. Considering the fact that blood transfusion is a life-saving treatment in many situations but it can also be a quick route for the transmission of infectious agents such as HIV, HBC, HCV, etc.; the Committee recommends that urgent measure be taken on war footing to regulate Blood Banks. The Committee desires to be furnished with a Status Note, indicating the initiatives taken by the Department towards ensuring quality management systems and monitoring of Blood Banks and the outcome thereof. 4.4 As per information received from the Department, the objective of blood safety programme under NACP-IV, supported the installation of Blood Component Separation Units and also funded 7 modernization of all major blood banks at State and district levels. A total of 229 component separation facilities (including 34 model blood banks) are presently being supported under the programme as on 31st December, 2012. A four-pronged strategy is as follows: (i) Ensuring that regular voluntary non-remunerated blood donors constitute the main source of blood supply through phased increase in donor recruitment and retention; (ii) Establishment of blood storage centres in the primary health care system for availability of blood in remote areas; (iii) Promoting appropriate use of blood, blood components and blood products among the clinicians; and (iv) Capacity building of staff involved in Blood Transfusion Service through an organized training programme for various categories of staff. 4.5 The Committee notes that during NACP-III, the Department had fulfilled the target of setting up 80 Blood Component Separation Units (BCSUs) at tertiary level of public health care delivery system and proposes to continue the support to these facilities and also take up upgradation of existing licensed blood banks in the Government and charitable sector with annual blood collection of over 5000 blood units at BCSUs, so as to saturate the same, by the end of NACP-IV. The Committee desires to be kept apprised of the progress made towards upgrading the existing licensed blood banks in the Government and Charitable Sector. 4.6 In reply to a query regarding the progress made towards establishment of the four Metro Blood Banks, the Department has informed that the four metro blood banks were proposed to be set up as four regional centres of excellence in Transfusion Medicine in Chennai, Delhi, and Kolkata and the proposal was approved in 2008. The total outlay for the scheme was Rs. 468.00 crore. There has been a delay in the above metro blood banks and their revised cost estimates now amounts to Rs. 1024.00 crore. The Department has also informed that the EFC has asked for a revised proposal and necessary action is being taken to prepare a revised proposal. 4.7 From the information furnished by the Department, the Committee gathers that the scheme pertaining to setting up of four Metro Blood Banks is yet to be approved by EFC, and time-overrun has led to the cost escalation of the scheme. The Committee deprecates the Department for not visualizing the problems of its implementation at the planning stage, which has resulted in time-overrun and cost escalation. The Committee recommends that the Department should expedite revision of proposal of the scheme and proactively pursue its approval with the EFC so that this scheme could be translated into action and there is no further cost-overrun. The Committee desires to be kept apprised of the updated status of approval of this scheme. The proposal brooks no delay and an expeditious action needs to be taken for its early approval. The Committee also impresses upon the Department to speed up the process for acquisition of land for the proposed Metro Blood Bank in Delhi.

V. Setting up of new District level Blood Banks 5.1 As per the information given in the Annual Report 2012-13 of the Department at present there are 909 NACO supported blood banks across the country which include 167 major blood banks and 742 district level blood banks. During NACP III, 39 newly created districts were identified which did not have Blood banks. NACO had taken the initiative with the concerned state Health Department for setting up blood banks in these districts. 8

5.2 The Committee has been informed that the blood needs of the State and region are estimated on the basis of population and blood need for the country is estimated to be 1% of the total population as per WHO norms. Accordingly, blood banks are set up in every district. In addition, Blood Storage Units are set up under National Rural Health Mission to cater to blood needs of first referral units at sub-district level health facilities. 5.3 In reply to a query, the Department has informed that a target of setting up of 39 blood banks was made during the Phase-III of NACP; however, only 27 blood banks were set up in the States of Jharkhand, Karnataka, Chhattisgarh Kerala, Mizoram and Uttar Pradesh. The details in this regard are given below:–

Sl. No. Name of the State Target for NACP-III Targets achieved (DLBB) 1. Bihar 1 0 2. Chhattisgarh 2 2 3. Jharkhand 11 6 4. Karnataka 4 3 5. Kerala 1 1 6. Mizoram 2 2 7. Uttar Pradesh 15 13 8. Uttarakhand 3 0

TOTAL :3927

5.4 39 blood banks were identified on the basis of an assessment of urgent requirement in underserved areas. When enquired about the reasons for non-completion of 12 blood banks, the Department has stated this was on account of various factors like non-completion of infrastructure, lack of equipments and non-acquisition of license. 5.5 The Committee expresses its disappointment that the Department has not been able to meet the target of setting up of 39 blood banks during NACP-III. In some states not even one blood bank was setup which gives a dismal picture of the implementation. The Committee feels that the above issues could have easily been sorted out, had there been a streamlined mechanism in place and the Department had pursued the matter vigorously. The Committee, therefore, recommends that the Department needs to play a pro-active role by taking up the matter with the concerned State Governments as well as the agencies at an appropriate level to expedite the procedural formalities. 5.6 The Committee has been informed that the Department is taking cognizance of the underserved areas including districts of Uttarakhand, Uttar Pradesh and Jharkhand in country wide plan for blood safety. More than 60% of the blood requirement of these States as per their population is catered through Department of AIDS Control supported blood banks. There are 11 DLBBs in Uttarakhand, 47 DLBBs in Uttar Pradesh and 18 DLBBs in Jharkhand supported by the NACO under the programme. On the reasons for some of the DLBBs not being functional in these States, the Department has informed the reasons for the same as lack of manpower, non-availability of health infrastructure for a blood bank and pending licences for operationalisation of these blood banks. 5.7 The Committee recommends that for resolving the problem of unfunctional District level Blood Banks (DLBBs), the Department should take up the matter with the Drug 9

Controller General of India regarding licencing and operationlisation of these blood banks on priority basis. The issues of shortage of manpower and lack of infrastructure should also be taken up with the States. The Committee also recommends that the Department should take special care of the underserved districts of Uttarakhand, Uttar Pradesh and Jharkhand.

VI. Integrated Counseling and Testing Centres (ICTCs)

6.1 As per the information given in the Annual Report-2012-13, this programme offers Counseling and Testing services for HIV infection, which includes three main components – Integrated Counseling and Testing Centres (ICTC), Prevention of Parent to child Infection, and HIV–TB Collaborative activities.

6.2 As per information furnished by the Department, the targets set for mothers who were to be tested and counselled during the years 2010-11, 2011-12 and 2012-13 and achievements made in respect thereof are as follows:–

2010-11 2011-12 2012-13 Target Achievement Target Achievement Target Achievement 86.49 66.38 90.00 85.63 90.00 57.10 lakhs lakhs lakhs lakhs lakhs lakhs

6.3 The Committee notes that the achievements vis-à-vis the targets fixed for 2010-11, 2011-12 and 2012-13 leaves a lot to be desired in the implementation of the targets. The Committee is of the opinion that the Department needs to fine tune its ground level machinery. The Committee therefore recommends that Department should focus on setting monitorable targets and their realization to the maximum extent. The Committee desires to be apprised of the targets fixed for 2013-14 and the measures put in place to monitor progress in this regard.

VII. Antiretroviral Therapy (ART) Centre

7.1 As per information given in the Annual Report 2012-13, as on December, 2012, nearly 17.36 lakh PLHIV have been registered at 380 ART Centres of whom 6,04,987 clinically eligible patients (including 34,367 children) are receiving free ART in Government health facilities.

7.2 The Department has informed that it is estimated that around 2.8% to 4% of PLHIV fail on first line ART after three years, which translates to nearly 34,000 PLHIV requiring second line ART by end of NACP IV (2017). Second Line ART was rolled out in 2008 at two centres of Excellence (CoE). This has now been extended to 17 CoEs and 24 ART Plus Centres to provide Second line ART drugs during 2013-14. 7.3 As per information received from the Department, another 24 ART centres would be upgraded to ART Plus centres in 2013-14 to provide second line ART drugs. It is also planned to have 7 more ART Plus centres in 2013-14. This will ensure that each State will have at least one ART centre to provide second line ART. All high prevalence states will have at least 3-4 centres to provide second line drugs.

7.4 The Committee recommends that the Department should ensure the achievement of targets set for upgradation of 24 ART centres to ART Plus Centres in 2013-14 and due diligence should be ensured that no delay should occur on this account. The Committee be apprised of the progress made in this regard. 10

7.5 On being asked about latest figures of the AIDS patients in the country state-wise and the last survey undertaken in this regard, the Department has stated that as per Reports received from the State AIDS Control Societies, as on December, 2012, the total number of AIDS patients in the country is 6,04,987 (State-wise details is given at Annexure). These are reported AIDS cases in ART centres across the country. For estimation of figures about AIDS patients, no specific surveys are undertaken, However, annual HIV sentinel surveillance is undertaken under the programme at periodic intervals for monitoring trends of HIV prevalence and HIV estimation purposes. 7.6 The Committee gathers from the information furnished by the Department that there is a steady decline in overall prevalence of HIV/AIDS. However, a lot still remains to be done. The Committee, therefore, recommends that during NACP-IV, additional ART Centres be established and high quality treatment be made available to the eligible people. The Committee also recommends that pre-ART follow-up be strengthened and all people eligible for treatment identified.

VIII. New Initiatives

(i) Setting up of National Blood Transfusion Authority (NBTA) 8.1 The Committee was informed that the proposal for setting up of National Blood Transfusion Authority was one of the approved activities under NACP phase-III. A vision document on NBTA was prepared in 2008 which was reviewed during a meeting of experts. A draft cabinet note was prepared and sent to various departments such as Department of Expenditure and Economic Affairs, under Ministry of Finance, Department of Health and the Planning Commission for comments in September, 2009. However, the Ministry of Finance could not support the proposal due to certain reasons. Thereafter, the Department did not pursue the matter further for setting up of National Blood Transfusion Authority. Subsequently, a Committee was set up by Department of Health on creation of National Blood Service under the chairpersonship of Additional Secretary and Director General (CGHS) and two meetings were held on 22nd November, 2011 and 23rd March, 2012 to consider the following issues: (i) Necessity of having a separate legislation for setting up of National Blood Transfusion Authority (NBTA) (ii) Amendment to Rules and Regulations of Drugs and Cosmetics Act to strengthen the regulatory mechanisms for grant of approval of blood banks and enforcement of rules and regulations relating to proper functioning of blood banks (iii) Synergizing the structures of National AIDS Control Organization and Indian Red Cross Society to have a strengthened National Blood Service. 8.2 The report of the Committee is still awaited. 8.3 The Committee is not happy with the slow progress in establishing the National Blood Transfusion Authority and the proposal is still on paper only. The Committee desires that the Department should formulate its stand on the issue on a priority basis and take an early decision.

(ii) Setting up of Plasma Fractionation Centre (PFC) 8.4 It has been informed by the Department that under NACP-III, it was proposed to set up a Plasma Fractionation Centre with a processing capacity of more than 1.5 lakh litres of plasma annually. These plasma derivatives will be provided to the public sector hospitals at affordable prices for treatment of economically weaker sections to ensure equitable access to the life saving 11 products and achieve self sufficiency in the availability of plasma derivatives in the country. A large volume of excess plasma in the country is being discarded, as there is no such centre in the public sector in the country. The project was approved in 2008, The Government of Tamil Nadu has provided land to NACO for the purpose. 8.5 As per latest information provided by the Department, a sub- Committee of national and international experts would be set up to discuss and explore the possibility of recombinant Factor-VIII and Factor-IX or any other new technology which might be more viable/appropriate than the existing proposal on preparation of Factor-VIII and Factor-IX of plasma. In this regard, a Committee has been set up and its report is awaited. 8.6 The Committee notes that the project for setting up of Plasma Fractionation Centre was approved in 2008. Almost 5 years have elapsed since then and there is no indication that it will see the light of day in the near future. The Committee, therefore, impresses upon the Department to make all out efforts for expediting submission of the report of Sub- Committee of experts so that further follow-up action could be initiated without further delay. An early decision is appreciated.

IX. Adolescence Education Programme (AEP) 9.1 Adolescence Education Programme (AEP) runs in secondary and senior secondary schools to build up life skills of adolescents to cope with the physical and psychological changes associated with growing up. The programme is being implemented in 23 States and till date 85,000 schools have been covered. As the follow-up to the suspension of AEP in some States, a toolkit was devised and disseminated for resumption of the programme in some of the States where it was suspended. 9.2 As per information received from the Department, after the suspension of Adolescence Education Programme (AEP) in some States, the material on Adolescence Education Programme had been reviewed by an expert committee constituted by DAC in consultation with Ministry of HRD and NCERT during 2007-08. The revised prototype material was disseminated to States in a consultation held in July, 2008. All States were requested to adapt and contextualize the material further to suit the local needs of students. Most States have adapted and contextualized the material in consultation with local experts and stakeholders and have been implementing AEP either directly or through NRHM. But, despite Department’s continuous advocacy efforts, the programme remained suspended in five States including Chhattisgarh, Karnataka, Maharashtra, Madhya Pradesh and Uttar Pradesh. 9.3 It has also been informed that, recently Karnataka has made notable progress in integration of content on HIV prevention in curriculum for school students through other ongoing programmes such as school health program under NRHM. This followed an effort by the State AIDS Prevention and Control Society which had taken up the matter with the State Education Department. The Department of AIDS Control is also continuing its efforts through State AIDS Control Societies to remove apprehensions and concerns in other States where there are problems in implementation of AEP. 9.4 The Committee is concerned to note that Adolescence Education Programme (AEP) remains suspended in five States namely, Chhattisgarh, Karnataka, Maharashtra, Madhya Pradesh and Uttar Pradesh. The Committee reiterates its earlier recommendation made in its 57th Report on Demand for Grants (2012-13) of the Department that it should vigorously take up with the States where the Programme is still under suspension and resolve their apprehensions in view of the fact that HIV/AIDS usually attacks the vulnerable population due to lack of awareness of the devastating effects the disease could have on them. The Department may take up the matter with all concerned States and clarify their apprehensions. The States also should understand the necessity of the programme. 12

X. New Strategies

(i) Setting up of District AIDS Prevention and Control Units (DAPCUs) 10.1 The Department has informed that DAPCUs have been established in 189 high priority (A and B Category) districts spread across 22 States under NACP-III. DAPCUs have been established in all ‘A’ and ‘B’ category districts (189) as per the categorization of high prevalence and vulnerable districts including the three districts i.e. Deoria (September, 2010) and Etawah (in February, 2011) of UP; Sonitpur district was changed to Kamrup in Assam,SACS based on severity of HIV epidemic. Further the DAPCU in Kamrup district was established in August, 2010. 10.2 As per the information received from the Department, DAPCU staffs are trained on different components of National AIDS Control Programme for effective monitoring and coordination at the district level. They are also trained on their roles and responsibilities with respect to different programmatic interventions at the district level with an aim to involve line departments through district administration. Further, DAPCU staff (953 in induction training and 348 in refresher trainings) have been trained through national level training for DAPCU. 10.3 The Committee is of the opinion that setting up of the District AIDS Prevention and Control Units function as a supportive structure below the state level and would fill up the necessary gaps to coordinate the activities at the district level as DAPCUs are expected to play a pivotal role in monitoring and coordination of delivery from the different facilities in the district. The Committee would, therefore, recommend that the Department should explore the possibility of expanding the same to more districts in the near future so as to implement the programme more effectively.

(ii) Scheme of link workers in rural areas of category A and B districts 10.4 As per information received from the Department, the Link Worker Scheme is supported by the Global Fund for AIDS, TB and Malaria Round (GFATM)- VII and has the mandate for implementation in 163 high prevalent and highly vulnerable districts till August, 2013. The Link Worker Scheme is being implemented in 155 districts. In the States of Chhattisgarh (4 districts), UP (3 districts) and Rajasthan (1 district) selection is due and the scheme is expected to be operational by end of March, 2013. In 2012-13, a total of 12391 and 15437 Red Ribbon Clubs and Village Information Centres were functioning. A total of 21066 Condom Depots were functioning leading to easy accessibility of condoms to the target population at the village level. Locale-specific and culture-specific IEC programmes were organized to reach out to the rural people, especially the vulnerable and high risk population. 10.5 The Committee notes that the Link Worker Scheme is an intensive rural-based intervention reaching out to the marginalized groups which remain uncovered even after the expansion of urban based prevention programmes. The Scheme is being implemented only in 155 districts as of now. The Committee recommends to the Department to assess the need to cover the remaining districts and closely monitor the scheme as the success of this scheme is crucial for achieving the goal of halting and reversing the epidemic of AIDS. Effective implementation of this scheme can bring perceptible change.

(iii) Preferred private provider scheme for management of Sexually Transmitted Infections (STYI) among high risk groups. 10.6 As per information provided by the Department, STI services are provided to HRGs through 3564 preferred private providers across the country. All these providers have been trained on standardization training curriculum to provide STI services. During the period April, 2012 to 13

January, 2013, about 25.8 lakh clinic visits were made by High Risk Group individuals for STI services from the preferred providers. In order to detect hidden STI and promote health seeking behaviour, HRGs are being encouraged to undergo quarterly regular medical check up and bi-annual syphilis testing. 17.57 lakh regular medical check ups were conducted, 6 lakh syphilis tests were conducted and syphilis positivity was found to be 0.4%. Seven percent of HRGs were diagnosed with serious STIs and treated through syndromic case management using colour coded STI/RTI drug kits. 10.7 This is very good scheme which has the potential to penetrate to the lowest level provided it is implemented with dedication. The Committee recommends close and strict monitoring of the Preferred Private Providers Scheme to ensure that it is not misused for financial benefits by the preferred private providers and strict norms should be put in place for identifying the preferred private providers for management of sexually transmitted infection.

XI. National Pediatric HIV/AIDS Initiative 11.1 The Committee has been informed that the National Pediatric HIV/AIDS Initiative was launched on 30 November, 2006. As on December, 2012, nearly 1,12,385 children living with HIV/ AIDS (CLHIV) are registered in HIV care at ART centres of whom 34,367 are receiving free ART. Pediatric formulations of ARV drugs are available at all ART centres. Currently, provision of second line ART for children has been made available at all COEs, pediatric CoEs and ART Plus centres. Prevention of Parent to Child Transmission of HIV(PPTCT) programme was started in 2002 and aims to prevent the parental transmission of HIV from an HIV infected pregnant mother to her new born baby. HIV positive women and the new born are given prophylactic drugs to prevent transmission of HIV from mother to child. The PPTCT programme is transitioning from single dose Nevirapine to the more efficacious multi drug regimen in a phased manner. 11.2 In response to a query regarding the status of HIV positive children in high risk states of Andhra Pradesh and Maharashtra, the Department has submitted that 23,269 HIV positive children have been registered and 5978 eligible HIV positive children are on pediatric ART in Andhra Pradesh whereas, 25,833 HIV positive children have been registered and 8627 eligible HIV positive children are on pediatric ART in Maharashtra. The Committee is also given to understand that rising trends of HIV prevalence among pregnant women are noted in some low prevalence/vulnerable States of North India including, Bihar, Gujarat, Uttar Pradesh, and Rajasthan. 11.3 The Committee is of the view that the Department needs to delve deeper on the reasons for rising trends of HIV prevalence among pregnant women in the State like Bihar, Gujarat, Uttar Pradesh and Rajasthan. The Committee recommends that the Department should prepare specific State-wise interventions in these States after analyzing the reasons for increase in HIV prevalence in these States and if need be specific pilot projects for interventions on PPP mode may be mooted with specific targets being fixed under these projects. 11.4 As per information received from the Department, a national task force was constituted with representatives from MWCD and DAC, UNICEF, USAID, FHI 360, India HIV/AIDS Alliance and the Clinton Foundation. A joint proposal was prepared to pilot this intervention for children affected with AIDS (CABA). It was implemented in 10 districts and concluded on 31st March, 2012. Overall 7601 HIV infected children and 38121 HIV affected children were enrolled in this intervention. Nearly 48000 field level health care providers and other Government functionaries were trained to provide linkages as envisaged in this intervention. 11.5 The Committee welcomes the initiatives taken by the Department in constituting a national task force under which there is a joint proposal to pilot this intervention for 14 children affected with AIDS (CABA). The Committee recommends that the Department should expand similar initiatives to other affected districts which would help in complementing and supplementing the Government’s efforts in its fight against combating HIV/AIDS.

XII. Information, Education and Communication (IEC) 12.1 The Committee has been informed that the various interventions have been initiated for carrying out IEC campaigns, like theme-wise campaigns for promoting HIV counseling etc, mass media campaigns, booklets for High Risk Groups etc., folk media campaign Red Ribbon Express Project (RREP). RREP, a special exhibition train can be rightly considered as world’s largest mass mobilization against HIV/AIDS which covered 162 stations in 23 States reaching out to about 1.14 crore people and training one lakh district resource persons. 12.2 The Department has informed that the following are the key achievements during the Eleventh Plan. · Mass Media Campaigns on different thematic areas · Focus areas: Condom Promotion, Youth, Stigma and Discrimination, ICTC/PPTCT, ART and Blood Safety · Successful completion of 3rd phase of the Red Ribbon Express (RRE) · Migrant IEC campaign launched at transit and source points in 8 out-migration States · Multi-media campaign in the North-East was upscaled to cover all 8 States in the North–East · Evaluation of Drop-in-Centres and SHGs · Inter-ministerial conference to mainstream HIV · 3.61 lakh frontline workers of other ministries trained. 12.3 The Committee feels that Information, Education and Communication is the backbone to ensure success of various schemes carried out by the Department. The Committee would like the Department to orient IEC activities towards laying greater focus on behavior change and strengthening the enabling environment. The Department should also design more media campaigns to address stigma and discrimination attached with HIV/AIDS. The Committee desires that more aggressive IEC activities are required to bring perceptible change.

XIII. HIV/AIDS Bill 13.1 The Committee has been given to understand that an International Policy Makers Conference on HIV/AIDS jointly organized by NACO, Indian Council of Medical Research (ICMR) and International AIDS Vaccine Initiative (IAVI) was held in May, 2002 in New Delhi which was attended by Parliamentarians and senior bureaucrats from eight countries. At the end of the conference, all the countries pledged to “strengthen legislation and regulatory systems” to fight the HIV/AIDS epidemic. As a follow up to the conference, a working group of experts on policy, legal, gender, ethics and technical matters was set up to advise on various HIV/AIDS prevention, care and treatment issues. NACO and ICMR were also part of the group. The group and the then Law Minister, requested Lawyers Collective’s HIV/AIDS Unit (LCHAU) to undertake the task of preparing a draft law on the subject. The draft of the HIV/AIDS Bill, 2006 prepared in consultation with key stakeholders at national and regional level was submitted to NACO on 30th June, 2006 by the Lawyers Collective. 15

13.2 Giving latest information in this regard, the Department has informed that as advised by the Ministry of Law and Justice, a note along with the draft of the HIV/AIDS Bill was prepared and circulated in March, 2012 to various Ministries for comments. Comments received from the Ministries were incorporated in the draft Bill and the draft Cabinet Note alongwith the draft Bill was sent to the Ministry of Law and Justice for vetting. Legislative Department, Ministry of Law and Justice returned the file to this Department with certain comments. Then, again the Bill was submitted to Ministry of Law and Justice after making changes, as suggested by the Ministry and the reply is still awaited. 13.3 The Committee observes that much delay has already taken place in introducing the AIDS Bill in Parliament. The Committee recommends that the Department should proactively pursue the matter for getting the Bill vetted from the Ministry of Law and Justice without any further delay so that the Bill may be introduced in the Parliament at the earliest. The Committee does not understand the reasons why it should take more than ten years to finalise a Bill when a decision was taken in 2002. The Bill is yet to be finalized. The delay is not justifiable when the problem is enormous and India is third largest AIDS/ HIV affected Country.

XIV. Miscellaneous 14.1 The Committee observes that there were invariably delays in procurement of HIV kits, which resulted in patient care suffering on this account. The Committee, therefore, impresses upon the Department to streamline the process of procurement of HIV kits and ensure strict monitoring of the same so as to eliminate delays in procurement thereof. 16

OBSERVATIONS/RECOMMENDATIONS — AT A GLANCE

II. Budgetary Allocation The Committee observes that the 1st year of the 12th Plan Period has already elapsed and the 2nd Year is in progress. However, the Department is still in the process of reworking the project cost of NACP-IV for the 12th Plan period. The Committee observes that the delay of more than a year in finalization of the project cost of such a critical programme like NACP-IV is a sad commentary on the working of the Department and calls for urgent remedial measures. The Committee feels that the delay will have an adverse impact on the intended outcomes of NACP-IV unless timely action taken. In an era of e-governance and with IT resources currently available, the Department should have finalized the project cost long back. The Committee, therefore, deprecates the delay in this regard and desires to be apprised of the reasons for the same. The Committee recommends that the Department should finalize the project cost at the earliest and in such a manner so that the intended outcomes of this programme are not adversely affected. The Committee may be apprised of the progress made in this regard. (Para 2.3) The Committee observes that in a resource constrained country like India, the efficient deployment of the available resources is the key for success of any programme/ scheme. The Committee, therefore, recommends that the Department should initiate concrete measures for efficient use of the allocated funds and remove apparent inefficiencies at every level of programme implementation. (Para 2.5) The Committee expresses its serious concern that the actual expenditure of the Department for the year 2010-11 was Rs. 1167.21 crore as against the BE of Rs. 1435.00 crore; for the year 2011-12, Rs. 1313.86 crore as against BE of Rs. 1700.00 crore, and for the year 2012-13, Rs. 1345.16 crore as against BE of Rs. 1700.00 crore. The Committee expresses its disappointment at this persistent trend of under-utilization of the budgeted funds and is of the view that this trend is not only indicative of fiscal indiscipline but also points to slack monitoring of utilization of the sanctioned provisions. The Committee feels that the reasons adduced by the Department cannot justify shortfall in expenditure to the tune of 267.79 crore in 2010-11, Rs. 386.14 crore in 2011-12 and Rs. 354.84 crore in 2012-13. The Committee, therefore, recommends that the Department should put in place a strict and effective monitoring mechanism to ensure that the funds allocated to the Department are monitored quarterly, and exercise utmost fiscal prudence and discipline so as to make realistic Budget Estimates in future. The Committee desires to be apprised of the measures initiated in this regard. (Para 2.9) The Committee appreciates that due to the efforts made by the Department, there has been a considerable decline in unspent balances available with the SACS. The Committee would, however, like to point out that availability of unspent balance with some SACS, like Andhra Pradesh SACS (Rs.23.33 crore), Bihar SACS (Rs.18.23 crore), Gujarat SACS (Rs.14.58 crore), Karnataka SACS (Rs.26.60 crore) is still quite high. The Committee emphasizes that the Department should make concerted efforts to get resolved all the unspent balances with the societies so that funds do not accumulate and remain unutilized. The Committee recommends that in order to ensure timely and effective utilization of unspent balances, the Department should insist on quarterly feedback from all the State

16 17

AIDS Control Societies. Close monitoring of their activities and spending will certainly deliver the desired results. (Para 2.12) The Committee takes note of the submission that the increased grants to SACS is due, transitioning of Targeted Intervention (TI) projects from Development Partners into the national programme. The Committee observes that funding from Development Partners have played a vital role in supporting the NACP programme interventions in the past. The Committee would, therefore, like to be apprised of the reasons behind shifting the TI projects from Development Partners to the national programme and its implication on funding of HIV programmes in the Country. (Para 2.14)

III. Role of NGOs The Committee expresses its displeasure over the issue of non-recovery of unspent balances from the NGOs by the Department, even after about two years. Out of 27 States, 11 States have a balance of Rs.100.8 lakhs still to be recovered. The Committee recommends that the issues like contract norms fixed for NGOs-State-wise, the reasons for delay in recovering the same along with the details of action taken against the NGOs who have repeatedly defaulted in paying back the unspent balances. In future, funds should be released only to such agencies which have the capacity to utilize the allocated amount. (Para 3.2)

IV. Setting up of new Blood Component Separation Units (BCSUs) The Committee is not aware as to what headway has been made towards concretizing the above proposal. Considering the fact that blood transfusion is a life-saving treatment in many situations but it can also be a quick route for the transmission of infectious agents such as HIV, HBC, HCV, etc; the Committee recommends that urgent measure be taken on war footing to regulate Blood Banks. The Committee desires to be furnished with a Status Note, indicating the initiatives taken by the Department towards ensuring quality management systems and monitoring of Blood Banks and the outcome thereof. (Para 4.3) The Committee notes that during NACP-III, the Department had fulfilled the target of setting up 80 Blood Component Separation Units (BCSUs) at tertiary level of public health care delivery system and proposes to continue the support to these facilities and also take up upgradation of existing licensed blood banks in the Government and charitable sector with annual blood collection of over 5000 blood units at BCSUs, so as to saturate the same, by the end of NACP-IV. The Committee desires to be kept apprised of the progress made towards upgrading the existing licensed blood banks in the Government and Charitable Sector. (Para 4.5) From the information furnished by the Department, the Committee gathers that the scheme pertaining to setting up of four Metro Blood Banks is yet to be approved by EFC, and time-overrun has led to the cost escalation of the scheme. The Committee deprecates the Department for not visualizing the problems of its implementation at the planning stage, which has resulted in time-overrun and cost escalation. The Committee recommends that the Department should expedite revision of proposal of the scheme and proactively pursue its approval with the EFC so that this scheme could be translated into action and there is no further cost-overrun. The Committee desires to be kept apprised of the updated status of approval of this scheme. The proposal brooks no delay and an expeditious action needs to be taken for its early approval. The Committee also impresses upon the Department to speed up the process for acquisition of land for the proposed Metro Blood Bank in Delhi. (Para 4.7) 18

V. Setting up of new District level Blood Banks The Committee expresses its disappointment that the Department has not been able to meet the target of setting up of 39 blood banks during NACP-III. In some states not even one blood bank was setup which gives a dismal picture of the implementation. The Committee feels that the above issues could have easily been sorted out, had there been a streamlined mechanism in place and the Department had pursued the matter vigorously. The Committee, therefore, recommends that the Department needs to play a pro-active role by taking up the matter with the concerned State Governments as well as the agencies at an appropriate level to expedite the procedural formalities. (Para 5.5) The Committee recommends that for resolving the problem of unfunctional District level Blood Banks (DLBBs), the Department should take up the matter with the Drug Controller General of India regarding licencing and operationlisation of these blood banks on priority basis. The issues of shortage of manpower and lack of infrastructure should also be taken up with the States. The Committee also recommends that the Department should take special care of the underserved districts of Uttarakhand, Uttar Pradesh and Jharkhand. (Para 5.7)

VI. Integrated Counseling and Testing Centres (ICTCs) The Committee notes that the achievements vis-a-vis the targets fixed for 2010-11, 2011-12 and 2012-13 leaves a lot to be desired in the implementation of the targets. The Committee is of the opinion that the Department needs to fine tune its ground level machinery. The Committee therefore recommends that Department should focus on setting monitorable targets and their realization to the maximum extent. The Committee desires to be apprised of the targets fixed for 2013-14 and the measures put in place to monitor progress in this regard. (Para 6.3)

VII. Antiretroviral Therapy (ART) Centre The Committee recommends that the Department should ensure the achievement of targets set for upgradation of 24 ART centres to ART Plus Centres in 2013-14 and due diligence should be ensured that no delay should occur on this account. The Committee be apprised of the progress made in this regard. (Para 7.4) The Committee gathers from the information furnished by the Department that there is a steady decline in overall prevalence of HIV/AIDS. However, a lot still remains to be done. The Committee, therefore, recommends that during NACP-IV, additional ART Centres be established and high quality treatment be made available to the eligible people. The Committee also recommends that pre-ART follow-up be strengthened and all people eligible for treatment identified. (Para 7.6)

VIII. New Initiatives (i) Setting up of National Blood Transfusion Authority (NBTA) The Committee is not happy with the slow progress in establishing the National Blood Transfusion Authority and the proposal is still on paper only. The Committee desires that the Department should formulate its stand on the issue on a priority basis and take an early decision. (Para 8.3)

(ii) Setting up of Plasma Fractionation Centre (PFC) The Committee notes that the project for setting up of Plasma Fractionation Centre 19 was approved in 2008. Almost 5 years have elapsed since then and there is no indication that it will see the light of day in the near future. The Committee, therefore, impresses upon the Department to make all out efforts for expediting submission of the report of Sub- Committee of experts so that further follow-up action could be initiated without further delay. An early decision is appreciated. (Para 8.6)

IX. Adolescence Education Programme (AEP)

The Committee is concerned to note that Adolescence Education Programme (AEP) remains suspended in five States namely, Chhattisgarh, Karnataka, Maharashtra, Madhya Pradesh and Uttar Pradesh. The Committee reiterates its earlier recommendation made in its 57th Report on Demand for Grants (2012-13) of the Department that it should vigorously take up with the States where the Programme is still under suspension and resolve their apprehensions in view of the fact that HIV/AIDS usually attacks the vulnerable population due to lack of awareness of the devastating effects the disease could have on them. The Department may take up the matter with all concerned States and clarify their apprehensions. The States also should understand the necessity of the programme. (Para 9.4)

X. New Strategies

(i) Setting up of District AIDS prevention and Control Units (DAPCUS)

The Committee is of the opinion that setting up of the District AIDS Prevention and Control Units function as a supportive structure below the state level and would fill up the necessary gaps to coordinate the activities at the district level as DAPCUs are expected to play a pivotal role in monitoring and coordination of delivery from the different facilities in the district. The Committee would, therefore, recommend that the Department should explore the possibility of expanding the same to more districts in the near future so as to implement the programme more effectively. (Para 10.3)

(ii) Scheme of Link Workers in Rural Areas of Category A and B Districts

The Committee notes that the Link Worker Scheme is an intensive rural-based intervention reaching out to the marginalized groups which remain uncovered even after the expansion of urban based prevention programmes. The Scheme is being implemented only in 155 districts as of now. The Committee recommends to the Department to assess the need to cover the remaining districts and closely monitor the scheme as the success of this scheme is crucial for achieving the goal of halting and reversing the epidemic of AIDS. Effective implementation of this scheme can bring perceptible change. (Para 10.5)

(iii) Preferred Private Provider Scheme for management of Sexually Transmitted Infections (STYI) among high risk groups

This is very good scheme which has the potential to penetrate to the lowest level provided it is implemented with dedication. The Committee recommends close and strict monitoring of the Preferred Private Providers Scheme to ensure that it is not misused for financial benefits by the preferred private providers and strict norms should be put in place for identifying the preferred private providers for management of sexually transmitted infection. (Para 10.7) 20

XI. National Pediatric HIV/AIDS Initiative The Committee is of the view that the Department needs to delve deeper on the reasons for rising trends of HIV prevalence among pregnant women in the State like Bihar, Gujarat, Uttar Pradesh and Rajasthan. The Committee recommends that the Department should prepare specific State-wise interventions in these States after analyzing the reasons for increase in HIV prevalence in these States and if need be specific pilot projects for interventions on PPP mode may be mooted with specific targets being fixed under these projects. (Para 11.3) The Committee welcomes the initiatives taken by the Department in constituting a national task force under which there is a joint proposal to pilot this intervention for children affected with AIDS (CABA). The Committee recommends that the Department should expand similar initiatives to other affected districts which would help in complementing and supplementing the Government’s efforts in its fight against combating HIV/AIDS. (Para 11.5)

XII. Information, Education and Communication (IEC) The Committee feels that Information, Education and Communication is the backbone to ensure success of various schemes carried out by the Department. The Committee would like the Department to orient IEC activities towards laying greater focus on behavior change and strengthening the enabling environment. The Department should also design more media campaigns to address stigma and discrimination attached with HIV/ AIDS. The Committee desires that more aggressive IEC activities are required to bring perceptible change. (Para 12.3)

XIII. HIV/AIDS Bill The Committee observes that much delay has already taken place in introducing the AIDS Bill in Parliament. The Committee recommends that the Department should proactively pursue the matter for getting the Bill vetted from the Ministry of Law and Justice without any further delay so that the Bill may be introduced in the Parliament at the earliest. The Committee does not understand the reasons why it should take more than ten years to finalise a Bill when a decision was taken in 2002. The Bill is yet to be finalized. The delay is not justifiable when the problem is enormous and India is third largest AIDS/ HIV affected Country. (Para 13.3)

XIV. Miscellaneous The Committee, therefore, impresses upon the Department to streamline the process of procurement of HIV kits and ensure strict monitoring of the same so as to eliminate delays in procurement thereof. (Para 14.1) 21

MINUTES

IX NINTH MEETING (2012-13)

The Committee met at 10.30 A.M. on Friday, the 5th April, 2013 in Committee Room ‘A’, Ground Floor, Parliament House Annexe, New Delhi.

MEMBERS PRESENT 1. Shri Brajesh Pathak — Chairman

RAJYA SABHA 2. Dr. Vijaylaxmi Sadho 3. Shri Rasheed Masood 4. Dr. Prabhakar Kore 5. Shri Jagat Prakash Nadda 6. Shri Arvind Kumar Singh 7. Shri D. Raja 8. Shri H. K. Dua

LOK SABHA 9. Shri Kirti Azad 10. Shrimati Sarika Devendra Singh Baghel 11. Shri Kuvarjibhai M. Bavalia 12. Dr. Sucharu Ranjan Haldar 13. Dr. Monazir Hassan 14. Dr. Sanjay Jaiswal 15. Shri Mahabal Mishra 16. Shrimati Jayshreeben Patel 17. Shri Harin Pathak 18. Dr. Anup Kumar Saha 19. Dr. Arvind Kumar Sharma 20. Dr. Raghuvansh Prasad Singh 21. Shri P.T. Thomas 22. Shri Chowdhury Mohan Jatua

SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R.B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director Shri Pratap Shenoy, Committee Officer

23 24

*** Department of AIDS Control 1. Shri Lov Verma, Secretary 2. Ms. Aradhana Johri, Additional Secretary 3. Shri S.K. Srivastava, Additional Secretary (FA) 4. Dr. Shakuntala, Chief Controller of Accounts

*** I. Opening Remarks 2. At the outset, the Chairman welcomed Members of the Committee and briefed them about the agenda of the meeting i.e., examination of Demands for Grants (2013-14) of the * * * and taking of oral evidence of the Secretary of the * * * and AIDS Control in the forenoon session. II. *** II. Oral Evidence of the Secretary, Department of AIDS Control 4. Thereafter, the Committee heard the views of the Secretary and other representatives of the Department of AIDS Control with regard to the Demands for Grants (2013-14). The Secretary made a power point presentation on Demands for Grants (2013-14) of the Department inter alia highlighting the various issues such as (i) National AIDS Control Programme (NACP)-III achievements; (ii) declining trends of HIV epidemic in India (2007-11); (iii) Evidence of Programme Impact on reduction in New Infections with Scale-up of Prevention Strategies (2000-11) and AIDS- related Deaths with Scale-up of Anti-Retroviral Treatment (2007-11); (iv) Routes of HIV Transmission, 2012-13; (v) HIV Concentration in High Risk Group (HRG) and Bridge Population; (vi) Significant Expansion of Service Delivery; (vii) Emerging Vulnerabilities among Injecting Drug User (IDU) and emerging vulnerabilities due to migration of trans-genders, truckers; (viii) Need to ensure resources to fully address treatment requirements; (ix) goals and objectives of NACP-IV, (x) key priorities and achievements in 2012-13 and targets for 2013-14; (xii) key initiatives in care, support and treatment of AIDS; (xiii) IEC campaign and mainstreaming; (xiv) strategic information management; (xv) Budget Estimate and Expenditure, etc. During the course of the meeting, members raised a number of queries like decline in targets and achievements of the number of Blood Component Separation Units; delay in procurement of HIV test kits and services; status of land transfer for metro blood bank in Delhi; Adolescence Education Programme; shortage of number of condoms; projects of National/State Blood Transfusion Council, education and awareness about AIDS; measures initiated to remove stigma attached with AIDS; integration of treatment of other diseases with AIDS; training of doctors in the treatment of AIDS; number of children suffering from AIDS; link between AIDS and Narcotics; protection of generic medicines; challenges facing AIDS Control; etc. The Secretary and other representatives of the Department replied to some of the queries raised by the Members. He was then directed by the Chair to furnish detailed written replies to the queries, which remained unanswered, soon.

(The Committee then adjourned at 2.00 P.M. for lunch to meet again at 2.30 P.M.)

III. *** 5. A verbatim record of the proceedings of the meeting was kept.

6. The Committee then adjourned at 5.00 P.M.

*** Relate to other matters. 25

XI ELEVENTH MEETING (2012-13)

The Committee met at 3.00 P.M. on Tuesday, the 23rd April, 2013 in Room No. ‘67’, First Floor, Parliament House, New Delhi.

MEMBERS PRESENT 1. Shri Brajesh Pathak — Chairman

RAJYA SABHA 2. Shri Jagat Prakash Nadda 3. Shri Arvind Kumar Singh 4. Shri D. Raja

LOK SABHA 5. Shri Kirti Azad 6. Shri Kuvarjibhai M. Bavalia 7. Dr. Sucharu Ranjan Haldar 8. Dr. Sanjay Jaiswal 9. Shrimati Jayshreeben Patel 10. Dr. Anup Kumar Saha 11. Dr. Raghuvansh Prasad Singh

SECRETARIAT Shri P.P.K. Ramacharyulu, Joint Secretary Shri R.B. Gupta, Director Shrimati Arpana Mendiratta, Joint Director Shri Dinesh Singh, Deputy Director Shri Pratap Shenoy, Committee Officer 2. At the outset, the Chairman welcomed Members of the Committee and apprised them of the agenda of the meeting, i.e., consideration and adoption of * * * and Draft 67th, 68th, 69th and 70th Reports on Demands for Grants (2013-14) pertaining to Departments of Health and Family Welfare, AYUSH, Health Research and AIDS Control, respectively. He invited Members to share their specific suggestions for improvements and incorporation in the Draft Reports.

II. Adoption of the Draft Reports 3. The Committee then considered and discussed the five draft Reports mentioned above. A few changes were suggested by Members for incorporation in the Reports. After some discussion, the Committee adopted all the five Reports with some modifications. The Committee, thereafter,

*** Relate to other matters.

25 26 decided that the Reports may be presented to the Rajya Sabha and laid on the Table of the Lok Sabha on Friday, the 26th April, 2013. The Committee authorized its Chairman and in his absence, Shri D. Raja and Dr. Vijaylaxmi Sadho to present the Reports in Rajya Sabha, and Dr. Sanjay Jaiswal, and in his absence, Shrimati Jayshreeben Patel to lay the Reports on the Table of the Lok Sabha.

III. Study visit 4. * * *

5. The Committee adjourned at 3.35 P.M.

*** Relate to other matters. Printed at : Bengal Offset Works, 335, Khajoor Road, Karol Bagh, New Delhi-110005.