PartnersGF -2005-04-22
Comment: "Indian Government Bureaucracies Kill Off People Living with AIDS" (2)
Anonymous
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Dear Sir/Madam,
This is with reference to the subject mail. What is said is not much, but what is left unsaid is enormous. Permit us to add to the gory details which to say the least will be from people who have felt and undergone the trauma rather than people who have tried to get to the bottom of the Indian Bureaucratic mess.
The real Indian Bureaucracy does consist of people from the Indian Administrative Services, popularly known as the IAS and jocularly as the I Am Safe. Yes the safety net this status provides is the ultimate in our developing country and the fact that this class rules the country is an underrated and understated fact. Politics and politicians are ridiculed by all and sundry but the fact that our political class is not as literate as they could or should have been has given these I Am Safe classes the right and the might to rule over the country. Their wish in most cases is a command and in cases that they find obstacles in their path they collude to demolish the same on a collective basis.
Let us add to your write-up in detail Para by Para:
The fact that nearly 5000 people Living with AIDS are receiving AVR through the public sector is debatable. The fact that the public sector funds are of, by and for the public makes it more than convenient for the same to be spent on charitable causes. Hundreds of millions of dollars in assistance poured into India from the international donors land up where? This is the question that one and all should look at. The fact that International Donors and the Global Fund are supposed to keep the checks and balances in place before committing them and after disbursing them happens to be the basics of the grants is forgotten. The health of the Health Ministry should be healthy now as the same is being headed by a well qualified doctor of high esteem.
'Bureaucratic genocide,' will remain till checks and measures are in place for sure.
According to us the World Health Organization (WHO) figures can be taken with a pinch of salt as they are simply collating the data furnished to them by the same bureaucracy that has been held responsible for genocide.
Suffice to state that the data collated is from the public sector treatment centres and the state of the same and access to the same for the populace at large remains an open secret.
The GFTAM did sanction $122 Million in additional funds, without even a dollar being disbursed, but this was done without ascertaining the fact as to what happened to the funds sanctioned and disbursed earlier.
What good is the money in the bank if people for who it was meant have been cremated? Mumbai's JJ Hospital is one of the finest examples of Indian culture and the fact that the goals can be met if the players are selected in accordance with the results desired. The fact that JJ Hospital is saturated does mean that the global community has the responsibility to ensure that many more models on the same lines are made functional as soon as possible.
Mumbai is India's largest city and the city where dreams can become a reality. Hundreds of thousands of people migrate to Mumbai each year chasing their dreams or simply in search of a living. Experts will be horrified to find out that thousands out of these contract AIDS and unknowingly pass it on to their families. The stories of people who return to their roots from Mumbai with full blown cases to face their share of misery before death is not new. It is not only Mumbai but the people who have come back to their roots from Mumbai and such places are the ones who deserve the empathy rather than the apathy heaped on them.
If only 30,000 people in Mumbai need treatment now, then 300,000 people who have contracted this epidemic or passed it on to their families while making a living in Mumbai needed treatment in far flung areas of India yesterday if not a year back.
On the 19th of April a person leapt to his death upon being diagnosed as an HIV positive at the JJ Hospital and a day before the same one more person committed suicide under similar circumstances. These are stray incidents because they were reported but countless similar situations do take place which are never reported. The stigma that HIV/AIDS carries in the Indian society and the lack of awareness is creating a mess which even the global donors will find difficult to contain in the near future.
No treatment for Children with AIDS:
The WHO representative represents who? What is their role and what powers and infrastructure do they have are the issues one needs to ponder before going any further. WHO can only make and suggest plans but cannot and is not the implementing agency.
Though Mumbai AIDS Control Center staff acknowledged that 1,500 children are known to need treatment in Mumbai the number of children who loose their lives before they are five need also be taken into account. The infant mortality rate due to malaria will be an eye opener despite it being a curable epidemic.
Why in Mumbai, hardly anyone has any information on the formation of the Global Fund leave alone the delays in disbursal. Incredible is the fact that the Global Fund made $100 million available to India's CCM despite them having asked for only about $800,000 and yet insists that the proposals be routed through the CCM's only. It does appear that the Global Fund is simply there to grant funds and not monitor its effective usage nor is it interested in fighting/containing the three epidemics it was set up for.
The ATM part should be removed from the GFTAM and be known as The Global Fund only. It does dole out funds to the chosen ones without bothering to ascertain the factual aspect of its usage for the purpose it was granted. How is it that new funds are being asked for and allocated without having checks on the past deeds or misdeeds?
Dr. Vaswani of WHO, or for that matter anyone, will take the Global Fund grants with a pinch of salt unless the results of the grants result in the benefits to the people who need the same to save their lives. The original and subsequent announcements by NACO are not a pertinent issue as the past deeds of the same do not present a rosy picture. One the one hand defiance of logic is being brandished but on the other hand the logistics being supplied are the plans rolled out are lapped up without any questions. Dr Vasvani or Dr Gogate are not responsible for the state of Maharastra but are simply representing the local branch of NACO and can only do as much as they can within the given circumstances. They can at best give you the futuristic plans that they have been provided with.
The information available on the Global Fund website conceals more than it reveals: Sample this arithmetic: $37 million would provide treatment to 44,300 PLWA, this in effect means a sum of Rs.1628 million which translates into approx Rs. 36000/= per person. The fact that this will be of immense help to the PLWA is not debatable but the fact that despite the grants and funds being available it is not reaching people who need them on a now or never basis is something all should be concerned about.
Informed sources and their claims are of little solace to the PLWA. The material fact that "potentially 45000 lives could have been saved" but were not and the fact that the blame game is on is depressing. The CCM or the "bureaucratic" problems may be responsible to an extent but the real problem is the Global donors who despite being the donors are not able to get themselves into position wherein the funds granted trickle down to the targeted epidemics.
The claims of the Global Fund that it is trying to use partner agencies to speed up the process is a ruse to hide its failure in implementing of its core activity for which it has been set up.
Contradictions are the name of this game: on one hand it is claimed that $37 million was approved and could have taken care of 44,300 PLWA and your own calculations candidly state that for every $10 million, about 50,000 people should be able to receive treatment. Sorry we feel abut the fact that we are debating the prices and policies alone without doing much to ensure that the one's who needed the grants as of yesterday do get it tomorrow at least.
Irony is not in the fact that 45% of the $4.2 million grant agreement signed with the consortium of Indian NGO's was allocated for "infrastructure, human resources, and planning and administration," irony will be found in the percentage of wastage that is incurred in the governmental processes. The late Prime Minister of India Mr. Rajiv Gandhi had once candidly admitted that less than 10% of the governmental benefits reach the people/project it is meant for.
Informed sources and the others at Geneva should understand that the cancellation of the grants is not the solution. It will rather highlight the fact that the Global Fund and other donor agencies have failed in their stated mission.
Hiding behind the Indian bureaucracy and taking refuge in delays caused by them is one side of the coin, the factual aspect that the Global agencies have failed in their stated and promised mission is the actual fact The reality for the PLWA in the streets and homes are not the apathy that is heaped upon them by all and sundry locally, but the fact that the empathy promised by the global community remains a promise.
An actual example witnessed by us last year: upon reading the Global Fund advertisement for the 4th round of proposals a group of affected people did get very hopeful and excited, which turned into despair once the actual and factual aspects of the grants granted in the past and the fact that it was through CCM's and Govt. Channels became evident. It is not the paid bureaucrats alone who are responsible for the existing mess, the rage and anger amongst people affected with Aids/Malaria/TB, who are aware of the global grants, against the donors for their failure in reaching out to them is appalling to say the least.
Few if any (forget the PLWA) care for the delays in disbursement of funds by the GFTAM as they are fully aware that nothing is going to reach the people who need the grants. Surprise without a prize is the fact that the Executive Director did make a statement which is all over the local media today and is reproduced verbatim:
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Wednesday, April 20, 2005 (New Delhi):
India has been given another wake up call on the AIDS epidemic. The Executive Director of the Global Fund to Fight Aids has said that the epidemic in India is spreading rapidly.
Richard Feachem also maintained that nothing is being done to stop the
epidemic. He has warned that India has overtaken South Africa as the country with the most HIV positive patients.
India's total was put at 5.1 million, but the range estimate was far wider - from 2.5 to 8.5 million.
(Source: ttp://www.ndtv.com)
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The ED Mr. Richard Feachem highlights and glosses over the fact that nothing is being done to stop the epidemic. Yes sir you are right that nothing is being done but the fact that escapes him is that his organization is the one to be royally blamed for this. He is forgetful of the fact that the GFTAM is the Global agency with the singular agenda to fight the might of these three epidemics and that the failures are for him to accept as that of the organization that he represents.
The rationale to highlight Mumbai only by the crusaders provides evidence to the fact that all are interested in glory and the gory details. It does escape logic as to why does one only look at the surface and not the scarface. One needs to look at the far flung nooks and corners of the country to understand the reality. AIDS Hospice and their capacity depend on the aid provided to them. Our organization does very little work for Malaria in our area but this does not mean that it does not have the capability to do more but the fact that resources do limit the reach are the most misunderstood point.
The instance of India' first leprosy hospital, Niramay Niketan and the parallels of stigma and sufferings with AIDS patients is perhaps the only touching and true reflection. The factual admission and mentioning of the fact that despite cheap and effective remedies, 98% of India's AIDS patients are abandoned and left to die is a true reflection of the fact that this is not a local problem and the global community should come forward with all its empathy to address the issue at hand before it is too late.
The Neketen AIDS program and the fact that its director Mr Furtado being completely unaware of the Global Fund or the money sitting unused in Delhi and Geneva speaks volumes on the effectiveness of the commitments of the local as well as the Global Fund. There is no dearth of people who are willing to help in the fight against the might of the epidemics and the fact that in most cases the efforts are Himalayan cannot be ignored. The fact that many nameless and faceless organizations and individuals do much more than their so called glorious and GLOBAL peers for the PLWA and other such epidemics cannot be wished away.
Interestingly, the issue of only 4 women being sex workers and the Mumbai's infamous red-light area having approximately 8,000 HIV+ has been mentioned but an informed source has been quoted whilst stating casually that "when sex workers begin to be ill, the men who run the brothels send them back to their home villages to die" This is one issue that needs to be looked at in detail and it does raise many issues, foremost being: can anyone vouch for the estimated number of sex workers? leave alone the one's HIV+ AIDS does not make a person ill from day one and hence the transmission of this is a mission till the person falls ill. Who does or will track the transmission this spreads in their home villages.
No sir these issues are not worth writing they do need fighting. We have raised the issue earlier that raising the issue of Mumbai does not and will not address the issue. Mumbai is more aware of the AIDS issue and its repercussions but there do exist villages wherein the full form of AIDS is "Acute Income Deficiency Syndrome" and they are not aware of the impact of AIDS and its repercussions. This will be the problem area and will be beyond salvage not Mumbai.
The instance of Jyothis Terminal Care does highlight the fact that despite the odds there is hope and that things could be made better for PLWA, yes efforts in the right direction need to be made.
The question is not why India should be applying for a fifth round grant but is how come the Global Fund failed to make the impact it should have given the large amount of grants that lie unused in Geneva. The fact there is no dearth of deaths due to the epidemics and further that India has a large number of medical and Para medical personnel should have been enough for the Global Fund to be able to reach out to the people who need the care and empathy. Do not give grants to India but do something to address the epidemics that are Global in nature.
CCM fails PLWA or the Global Fund has failed the PLWA is a question that only time will tell. The fact that the CCM is a creation of the Global Fund has been forgotten.
The fact that the CCM can write lucrative proposals does emphasize that given the right push the CCM will apply themselves into fulfilling the proposals being implemented in its true spirit. The past failures of the CCM cannot be used as the reason to abandon the goals of the Global Fund and its obligations.
The Indian Government wanting to get rid of people with AIDS is misplaced and an isolated instance. Yes the fact remains that due to the structure of the society and the closed cultural environment that we do live in, AIDS is a deep stigma and it does mean that the entire family of an AIDS patient is looked at by apathy rather than the empathy they need in their hour of crisis.
Why are we trying to write when the ones who can change the scenario for the better choose to remain in the wilderness? No sir writing a big essay will not help but fighting for a small cause on our own will at least be the step.
Lethal GFTAM policies is not a term determined by us and neither endorsed. All we would want to see is that the fund does apply itself to fighting the three epidemics it was set out for. The interest that is generated from the money in the Swiss bank is not an issue to be debated, the flip side is that it grows and can be used for greater impact in fighting the epidemics.
The grants provided and left unused and its gory details are not relevant. What is relevant is the fact that Millions are dying due to TB/AIDS/Malaria despite the GFTAM in place. This is the true irony.