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INDIA COUNTRY COORDINATING MECHANISM

OVERSIGHT COMMITTEE VISIT TO BHARATPUR,

RAJASTHAN

REPORT

11th-12

th APRIL 2017

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Table of Contents

Sl.No. Content Page Nos.

1 Background 3

2 Objectives of the visit 3

3 PRs/SRS at Bharatpur District, Rajasthan 3

4 Activities undertaken by Oversight team during visit 4

5 SR-level meeting 4

6 Visit to PPTCT counseling centre at Janana Hospital, Bharatpur 10

7 Visit to District TB Clinic, Bharatpur 10

8 Visit to CHC Kumher 11

9 Visit to ART Centre- RBM Hospital, Bhartapur 12

10 Visit to Care and Support Centre under Vihaan Project 13

11 Debrief of Oversight Committee activities to Deputy CMO Bharatpur 14

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Oversight Committee Visit to Bharatpur, Rajasthan (11th

-12th

April 2017)

Background

An Oversight Committee of India Country Coordinating Mechanism (I-CCM) was constituted on 18th

January, 2016 for the period 2015-2018. The Committee planned an oversight visit to Bharatpur,

Rajasthan from 11th

-12th April 2017.

Objectives of the visit:

a) To oversee HIV grant and its implementation in Bharatpur by Principle Recipients and Sub

Recipients under the Global Fund.

b) To oversee TB grant and its implementation in Bharatpur by PRs and SRs under the Global Fund.

c) To apply the understanding of Oversight Committee training conducted on 10th April 2017 by a

team from Grant Management Solutions.

Five members of the Oversight Committee visited the site -

1. Dr. John Cherian Oommen, Christian Hospital, Oversight Committee Member

2. Ms. Laxmi Narayan Tripathi, Astitva trust- Oversight Committee Member

3. Ms. Sadhna Jadon, Plan India, Oversight Committee Member

4. Mr. Md. Hashmat Rabbani, Gramin Samaj Vikas Kalyan Manch, Oversight Committee Member

5. Ms. Priyanka Grover, Alternate to Ms. Kavita Singh (Oversight Committee Member)

The team was accompanied by India CCM Secretariat staff – Dr. Sandhya Gupta (CCM Coordinator) and

Dr. Benu Bhatia (Programme Officer, CCM) and Ms. Iryna Reshevska from GMS team.

PRs/ SRS at Bharatpur district, Rajasthan

The Global Fund grant is supporting five Principle Recipients –NACO, India HIV Alliance, Plan India,

RNTCP and UNION in HIV and TB programmes in Bharatpur district, Rajasthan for the period October,

2015- December, 2017 which are implementing projects through their SR and SSRs.

PR SR

NACO Rajasthan SACS )ART Bharatpur)

India HIV Alliance HLFPPT

Plan India Piramal Swasthya

CTD TISS

UNION PSI, Mamta

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Activities undertaken by Oversight team during visit:

The Oversight visit for Bharatpur, Rajsthan spanned over 2 days including a meeting with all concerned

SRs to gain information from them regarding the programme implementation at the site and site visits to

the following locations:

1. ICTC clinic, Janana Hospital, Bharatpur

2. District TB Clinic, Bharatpur

3. CHC Kumher

4. ART centre, RBM Hospital, Bharatpur

5. Vihaan Care and Support Centre

SR-level meeting

Oversight Committee held a meeting with Sub Recipients implementing Global Fund grant in Bharatpur

district, Rajasthan on 11th April, 2017, 2.00-5.00 pm at Janana Hospital Committee room to understand

activities undertaken, targets achieved, fund disbursement, expenditure status and challenges encountered

in program implementation. Representatives from Rajasthan SACS, HLFPPT, Piramal Swasthya, PSI,

Mamta and TISS made brief presentation with following highlights:

1. Rajasthan SACS: Bharatpur ART centre is functioning since February 2013 under Rajasthan SACS.

Dr. Subhash Bansal, Nodal Officer, Bharatpur ART centre shared information on total 1602 PLHIV

registered for HIV care, of which 1178 PLHIV are on active care and 1060 PLHIV are alive on ART till

March, 2017. As per the records, centre has 130 registered LFU till date. Around 2 to 3 newly diagnosed

cases are registered at ART centre daily with 15-20 are initiated on ART every month at Bharatpur ART

centre and are counselled and treated as per national guidelines. As per NACO guidelines, PEP medicines

are being kept in emergency OPD, general OT, Labour Room, ICU, Obst. OT and ART laboratory.

Challenges highlighted:

A. CD4 testing happens four days a week because district Bharatpur has no CD4 machine so

blood sample is collected and sent to CD4 labs at Alwar/Jaipur. Joint Director (CST),

Rajasthan SACS informed that state has only 9 CD4 machines. The Joint Director, RSACS

informed that NACO has assured that 7 new CD4 machines will be allotted to the state.

B. Human resource shortage at ART centre:

Joint Director (CST) highlighted the issue of poor retention of staff especially

Medical Officer at ART due to very low remuneration (Senior Medical Officer

salary-Rs. 45,000/month, Medical Officer- Rs. 36,000/month). Due to unsatisfactory

salary, ART centres across Rajasthan State are facing shortage of medical officers.

Since salary structure for SACS is decided at GoI level, request for revising salary

structure have also been made at GoI level.

As a temporary resort, Health Secretary, Rajasthan has asked doctors from

government hospitals to work additionally at ART centres. However due to excessive

workload, these doctors are not able to give sufficient time at ART centres.

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C. District has only two standalone ICTC centres- Janana hospital and CHC Dhaulpur, which are

not sufficient to counsel volume of patients which come for counselling and testing including

pregnant females. This also does not allow ICTC counsellor to undertake home visits.

2. AHANA project: The project aims to improve access to public sector PPTCT services in India. It is

being implemented in Rajasthan state (including Bharatpur district) by Piramal Swasthya, Sub Recipient

under Plan International (Principal Recipient) covering 52% districts of Rajasthan using Global Fund

grant for period Oct, 2015- Dec, 2017.

Key objectives of AHANA projects:

Building skills among peripheral health workers under general health system in PPTCT for

increasing the uptake of services

To conduct outreach and follow up of HIV Positive Women and HIV Exposed infants

Project activities in Bharatpur district:

(i) Key activities under AHANA project at district level include formation of District Resource Team

(DRT), Volunteers Team (Block Resource Team), conducting Community Mobilization Meetings

(CMM), Advocacy meetings, Coordination meeting with PLHIV network and DOT providers, Mid-

Media activity and outreach activities to generate demand for HIV screening of pregnant women etc.

(ii) Project is staffed with 1 District Officer (DO) and 3 Outreach worker (ORW) which works in

collaboration with district resource team and district level public health structures (district hospital, CHC,

PHC etc)

Key Achievements:

i. Project has undertaken following meetings at district level from period January, 2016-February,

2017:

ii. Project has worked towards improving access to PPTCT services by taking HIV Screening to the

Periphery i.e PHCs, and currently 41 out of 73 PHC’s in Bharatpur district are carrying out HIV

tests with increase in HIV test average from 137 tests (Jan-March, 2016) to 527 (Jan-Feb, 2017).

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15

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C O M M U N I T Y M O B I L I Z A T I O N M E E T I N G S

C O O R D I N A T I O N M E E T I N G W I T H P L H I V N E T W O R K A N D D O T

P R O V I D E R S

A D V O C A C Y M E E T I N G

P E R I O D : J A N , 2 0 1 6 - F E B , 2 0 1 7

Target Achievement

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iii. Project AHANA has achieved 75% of HIV testing (N-5460) against total ANC targets (7254)

during period Jan-Feb, 2017 compared to 23% HIV testing during initial phase of project in Oct,

2015-march, 2016.

Issue highlighted with respect to achieving targets:

• AHANA project state representative highlighted that there is gap in reporting of HIV screening

as per MCTS and SIMS. As per MCTS, number of Pregnant women (PW) screened for HIV

during 2016 were 3,97,759 while during same year SIMS reported HIV screening of only

2,36,106 PW. The main reason cited for this gap was non reporting of PHC level data at SIMS.

However close to 37% HIV screening happens at PHC and below level which is un-reported in

SIMS but gets reported under state HMIS (MCTS). Project AHANA is working towards fulfilling

this screening gap at SIMS and is planning to set up mechanism for SIMS reporting of PHC/SC

level HIV screening.

3. VIHAAN project: India HIV Alliance is the Principal Recipient under the Global Fund grant to

implement Vihaan project to improve the survival and quality of life of PLHIV by fulfilling their Care,

20 25 41 44 41

0

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(Jan 16 to Mar 16) (Apr 16 to Jun 16) (July 16 to Sep 16) (Oct 16 to Dec 16) (Jan 17 to Feb 17)

No. of PHCs carrying out HIV tests of pregnant women out of Total 73 PHCs in the District*

Active PHCs(>=1 HIV test)

13926

9429 9429

10881

7254

3181 4139

5726

6913

5460 23%

44%

61% 64%

75%

0%

10%

20%

30%

40%

50%

60%

70%

80%

0

2000

4000

6000

8000

10000

12000

14000

16000

Oct 15 to March 16 Apr 16 to June 16 July 16 to Sep 16 Oct 16 to Dec 16 Jan 17 to Feb 17

Percentage HIV testing of ANC against targets

Target Achievement Percentage

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support and treatment needs. In Rajasthan, Vihaan project is being implemented by HLFPPT as SR since

October, 2015 with Bharatpur Network for People Living with HIV/AIDS acting as SSR in Bharatpur

District. The main objectives of Vihaan project are:

• Early linkages of PLHIV to care, support and treatment services.

• Improved treatment adherence and education for PLHIV.

• Expanded positive prevention activities and Improving social protection and wellbeing of PLHIV.

• Strengthening community systems and reducing stigma

Project activities undertaken in Bharatpur district:

(i) Care, Support and treatment centre being run by SSR (Bharatpur Network for People

Living with HIV/AIDS) is staffed with Project Director (1), Project Coordinator (1),

Counsellor (1), Peer Counsellor (1), Accountant (1), Outreach workers (2).

(ii) Of the total 1154 PLHIV registered at ART Bharatpur, 976 (698 ON ART + 278 PRE

ART) are registered at Care Support Center from October, 2015 till February, 2017 for

accessing various service related to counseling, outreach, referrals and social scheme

linkage support.

(iii) eM- power mobile based outreach management application was introduced 6 months

back at CSC, Bharatpur to improve treatment adherence and increase in service uptake.

(iv) Achievement against core indicators till February,2017:

Bharatpur

S.

No. Core Indicator Description

Till February, 2017

Targets Actual

Results

Achievement

(%)

1 No of PLHIVs registered in ART Centre and are registered in

the CSC 1337 973 73%

2 No of PLHIV whose at least one family member or sexual

partner referred for HIV testing and received test result 111 107 96%

3 Proportion of PLHIV lost to follow up (LFU) brought back to

treatment 388 130 34%

4 Number of registered PLHIVs screened for TB symptoms (4S)

by CSC through ICF 973 672 69%

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(v) 78 Support Group Meeting, 17 ART-CSC coordination meetings and 3 Advocacy

meetings have been undertaken so far at Bharatpur District.

Challenges

(A) Challenges faced by SR

• Coverage of state with limited number of CSCs (only 16 CSCs are covering 23 ART)

• Inadequate systems related to Financial management of SSR also hampered the quality of

programme.

• Governance related issues at SSR level.

(B) Challenges faced by SSR

• Availability of qualified Human Resource within available budget

• Tracking of LFUs adjoining district due to available limited resources. Especially

outreach workers who are given travel allowance of Rs. 1000/- per month which is not

sufficient to undertake outreach activities. India HIV Alliance representative present in

the meeting mentioned that these allowances were decided at the beginning of grant in

agreement with NACO and were budgeted accordingly in the grant agreement with the

Global Fund. Salary revision at this stage will require additional budget which is not

feasible at PR level.

• Delay in disbursement at SR and SSR level for the last quarter. PR representative

informed that disbursement were delayed due to unsatisfactory financial reports from

field level for which SR and SSR have been guided and they will submit the updated

report.

Recommendation of OC:

(1) To understand the matter related to delayed financial disbursement and action taken by PRs,

Oversight Committee asked India HIV Alliance and Rajasthan state SR (HLFPPT) to provide

brief write-up on the matter.

(2) Oversight Committee also inquired details of Social Welfare schemes related targets and

achievements at SR and SSR level. The same is to be shared by SR with Oversight Committee.

4. Axshya Project:

The UNION is implementing project Axshya- TB control programme with focus on Key Affected

Population in Bharatpur district through implementing partners (SRs) - MAMTA Health Institute for

Mother and Child Health and Population Services International (PSI). Bharatpur is divided into 10 T.B

Units, with MAMTA and PSI implementing project Axshya in 5 T.B Units each.

Since October, 2015 to December, 2016, in Bharatpur district Axshya project has reached 1,50,000

people from various vulnerable and marginalized communities; facilitated identification and testing of

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nearly 2,500 TB symptomatic (including nearly 1300 sputum collection and transportation) and resulted

in initiation of DOTS for over 100 patients being diagnosed with TB.

Activities of PSI in Bharatpur District (for period Oct,2015-Dec, 2016):

i. PSI is working in Kumher, Bharatpur, Nagar, Bhusawar and Nadbai T.B units of Bharatpur

ii. Through Axshya Samvad (Active case finding), PSI has reached 15,055 households against target

of 13,500 for period Oct, 15-Dec, 2016) and was able to make 311 referrals to DMC of which 21

sputum positive cases were found and 13 of them were put on DOTS treatment.

iii. Undertook 662 Sputum Collection and Transportation of presumptive TB patients who are unable

to reach diagnostic, of which 46 were found sputum positive and 39 of them were put on DOTS.

iv. Has identified close to 10 Axshya Villages in Bharatpur to carry out TB awareness activities for

entire population for period Oct 2015-Dec, 2016.

v. No. of Rural Health providers and Ayush practitioners trained in Bharatpur are 75, of which 27

have been engaged so far for referrals, sputum collection and transportation and acting as DOT

providers.

vi. Conducted sensitization of 10 private laboratories on ban on serological tests for TB in Bharatpur.

vii. Overall PSI has contributed for 19.7 % of total TB symptomatic tested (as per lab register data)

and 11.5 % of total TB cases detected in Bharatpur district (register data).

Activities of MAMTA (for period Oct, 2015-Dec, 2016):

i. MAMTA is working in Deeg, Kama, Roopwa, Bayana and Pahari T.B units of Bharatpur.

ii. Through Axshya Samvad (Active case finding), MAMTA has reached 13500 households against

target of 15033 for period Oct, 15-Dec, 2016.

iii. Undertook 470 Sputum Collection and Transportation of presumptive TB patients who are unable

to reach diagnostic, of which 54 were found sputum positive and were put on DOTS.

iv. Has identified close to 15 Axshya Villages in Bharatpur to carry out TB awareness activities for

entire population.

v. Conducted 58 community meetings to sensitize Gaon Kalyan Samities (GKS/VHSNCs) and other

community groups (Mahila Mandals, Self Help Groups, Youth groups, schools etc) on TB and

gathering community participation in TB referral etc.

vi. Has sensitized around 500 prison inmates on TB so far.

Challenges:

Overall challenge highlighted by PSI and MAMTA was recruitment and retention of community

volunteers on account of low incentive being given to them to undertake household visit (Rs. 10

per household) and sputum collection and transportation (Rs. 100 per patient). Community

volunteers find it difficult to travel and undertake field visit within this remuneration and

frequently leave job. The matter was raised at the level of UNION as well according to which

incentives for Community volunteer has been maintained same all across the country and cannot

be changed for Bharatpur district alone.

5. Drug Resistance TB Counselor Project (Saksham):

i. TISS (Tata Institute of Social Sciences) is implementing the DRTB Counsellor Project in the

State of Rajasthan as SR under CTD.

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ii. Project aims to strengthen TB prevention, treatment and care programme through psycho-

social counselling services and to improve treatment adherence among MDR and XDR

patients through counselling and by linking them with required social protection services

iii. In Rajasthan, 34 Counsellors were appointed in the month of October’16 and trained in the

month of November’16 with active engagement of State RNTCP officials. Bharatpur district

also has one trained counsellor.

iv. As per information shared, in Bharatpur district for period Nov’16 to March ’17, 24 patients

were registered for counseling, of which 20 are continuing their TB treatment and 4 have

died. Of all these 20 patients, their family caregivers were also counseled and at least 1

follow up visit to 17 patents has been taken place.

Visit to PPTCT counseling centre at Janana Hospital, Bharatpur - 11th April

Oversight Committee visited PPTCT counseling centre at Janana hospital on 11th April and enquired from

the PPTCT counselor (Ms. Sangeeta) about the functioning of centre. She informed that:

i. On an average 1300-1400 pregnant women are counseled and tested per month for HIV. As

per the records, 1254 pregnant women were counseled and tested in the month of March’17

of which three (3) positive cases were identified and linked to ART centre.

ii. Position of Lab technician is vacant. Currently state level lab technician is supporting the

centre.

iii. It was observed that patient related information is being filled in two separate registers with

overlap of information in both the registers which unnecessary increased workload of

counselor. JD (CST) mentioned that state has already put up order for new comprehensive

single registers which will be provided to ICTC centres within 1-2 months to ease off

workload of counselors.

Team also verified the information provided by the counselor from registers and available records.

Visit to District TB Clinic, Bharatpur - 11th April, 2017

It was informed by DTO that Bharatpur district has 10 TUs and 23 DMCs. During period January to

March 2017, 3266 TB suspects were examined for diagnosis and 344 were found to be positive (Source:

Annexure M-2017 report). Total 714 patients are on treatment from Jan-March’17.

Out of 30 CBNAAT machines in the Rajasthan state, 27 have been procured under current NFM Grant of

the Global Fund by Central TB Division. In Bharatpur district, CBNAAT machine was installed on 30th

January 2016 in District TB Clinic in Janana Hospital campus. Oversight Committee visited to observe

functioning of CBNAAT machine in the hospital. The team met District TB Officer and Lab Technician

at the centre. It was informed that since CBNAAT installation (Jan, 2016) till March, 2017, around 458

tests have been performed. It has detected so far 189 MTB positive –Rifampicin sensitive and 55 MTB-

positive –Rifampicin Resistant cases. Average monthly consumption of the machine based on 2016

annual data is 29.

As per the stock register, 900 cartridges were supplied in Jan, 2016 and 1350 cartridges in September,

2016. DTO informed that as per state orders, some stock of cartridges was transferred to Dausa TB Clinic,

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SMS Medical College Jaipur and STDC Chennai to meet their cartridges shortfall. Currently, there were

192 cartridges available in the stock. DTO informed that new stock of cartridges is anticipated within a

month as per information from state RNTCP office.

It was learnt that two Lab Technicians, STLS and STC have been trained on use of CBNAAT who are

contractual staff. DTO informed that there is provision of keeping one Lab Technician for CBNAAT

machine which is being planned under Current PIP (Apr’17- March’18). At district Bharatpur under

RNTCP, 2 STLS positions are vacant.

Visit to CHC Kumher -12th

April, 2017

Oversight Committee visited CHC Kumher on 12th April, 2017 to observe field level activities of SRs-

PSI and Piramal Swasthya. CHC Kumher is located around 20 km from Janana Hospital, Bharatpur. It

covers population of 2.6 lakh and has 10 PHCs, 2 District Microscopic Centres (DMC Kumher & Raraha)

and 56 SCs under it.

OC visited Laboratory and interacted with Lab Technician to understand basic services being undertaken

at the CHC Laboratory. Around 35 types of routine tests are undertaken at the CHC. On an average 50

patients are tested daily, with 4-5 patients for T.B (Sputum AFB) and 4-5 patients for HIV screening tests.

Lab Registers were verified and one of the TB patient (Female, 13yrs) was called to enquire about her

treatment status. Her father informed that ASHA in their area does not visit his daughter to provide DOTS

treatment routinely. ASHA only provides them weekly medicines and does not follow up with them on

day to day basis. Mr. Hashmat Rabbani, Oversight Committee member went with STLS to visit the

patient to confirm the same.

Mr. Hashmat also visited one Drug Resistance TB patient who is currently under treatment and has

received treatment and psychosocial counseling under Drug Resistance TB Counselor project. MDR-TB

patient, Female, 48 yrs, Village Abaar, Block Kumher, District Bharatpur, Rajasthan shared her problems

with Md. Hashmat Rabbani. She shared that she hasn’t faced any issues with the treatment received

through RNTCP, however her family currently faces gross economic problems due to which her

nutritional needs are not met.

District Programme Coordinator for RNTCP was interviewed regarding the performance of Non

Government PRs in Bharatpur district. The performance for PSI was informed as satisfactory; however

issues were raised for Mamta SR where monitoring for upto SSR level poses difficulty. The Programme

Manager of PSI informed that quarterly reports from PSI are sent to STO. It was informed by the District

Program Coordinator under RNTCP that Mamta fails to provide regular activity plans/ targets.

OC met district team of PSI (District Coordinator-Mr. Santosh Kumar, Interpersonal Communication

Coordinator-Mr. Manish, Community Volunteer-Ms. Laxmi Devi) engaged in implementing Axshya

project in Bharatpur district. Community volunteer informed that she covers 4000-5000 population

around CHC Kumher with special focus on Key affected groups (selected in consultation with Senior

Treatment and Lab Supervisor) and undertakes Axshya Samvad (household visits for active case search)

and general awareness of TB in Axshya villages. She raised the concern of poor incentives being

provided to Community Volunteers under Axshya project for household visit (Rs. 10 per household) and

Sputum collection and transport (Rs. 100 per sample) which she finds demotivating and is planning to

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leave the position. District Coordinator reiterated that on account of poor incentives, it is difficult to

engage and retain Community Volunteers.

OC met GNM (Ms. Lalita Devi) on duty at Labour Room in CHC Kumher to enquire about PPTCT

services being provided at CHC and status of training of staff on PPTCT. She informed that all pregnant

females are screened for HIV at CHC and those found to be positive are linked to ART centre at Janana

hospital for further testing and treatment. She mentioned that staff nurses were trained on PPTCT 3-4

months back by Lab Technician at the CHC who is part of district resource team trained by AHANA

project team (Piramal Swasthya under Plan).

Visit to ART Centre-R.B. M Hospital, Bharatpur -12th

April 2017

Oversight Committee visited the ICTC centre and ART centre located at R.B.M Hospital at Bharatpur

district on 12th April, 2017 along with SACS officials- Joint Director (CST) and Additional Director

(BSD) to review the functioning of ART.

Oversight committee met Additional M.O (Dr. Manish) who has been posted temporarily from District

hospital to ART centre since M.O position is vacant at ART centre.

Team also met ICTC Counselor (Ms. Suman) who informed that ICTC centre at RBM hospital caters to

general patients and pregnant women are counseled and tested at PPTCT centre at Janana hospital. As per

last year records (Apr’16-March’17), total 4137 patients were counselled and tested for HIV at ICTC

RBM hospital.

Team met ART counsellor (Mr. Sameer Raghav) who informed that on an average 800 patients are

counseled per month for ART treatment. He further apprised that one position of ART counselor is vacant

at ART centre.

The Oversight team also visited the Pharmacy at the ART centre and found that adequate medicines were

stored and registers for patients and stock were maintained properly.

Officials (District Officer and Project Coordinator) from Piramal Swasthya (SR) and State Manager from

Plan India (PR) were interviewed. The functions of the SR are ensuring screening of women coming for

ANC and during labour if they have not been screened during ANC and training of ANMs (training has

been conducted over 3 months of Jan - Mar’17). The prime objective of AHANA project is to improve

access to PPTCT services in Rajasthan where they wish to link positive pregnant women with ART and

providing EID to HIV exposed infants. The SR is reviewed quarterly by the PR and LFA has once

conducted a financial audit.

The officials from the SR complained of non-sharing of line list of HIV+ ANC by ICTC counselors as

they have not been assigned to do so. The issue was discussed by the Oversight Committee with

Additional Director (BSD). He informed that letters have been sent to the PPTCT counselors regarding

sharing of line list with Plan India officials; however, it is dependent upon provision of consent from the

patient. The State Manager from Plan India requested the network (BNP+) to help in providing consent

from the patient.

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On the other hand, it was informed that Coordination meetings at the district level are conducted, which

are attended by staff of the ART centre and associated Non government organizations in that area. Such

meetings are conducted to ensure sharing of information (achievements and issues) at district level

pertaining to HIV control services. The staff from Vihaan regularly attends such meetings; however staff

from Piramal Swasthya has not attended any coordination meeting up till now. This was confirmed by

reviewing few participants’ lists. The staff from Piramal Swasthya informed that they were never

informed regarding such meetings.

The Oversight Committee observed gross miscommunication and coordination gap among officials from

SACS and Piramal Swasthya which may in turn reflect poorly on provision of services to the patients.

OC recommendation:

The Committee recommended that information regarding meetings must be shared with all concerned

Non Government partners, and officials from Piramal Swasthya must attend such meetings so as to ensure

a healthy dialogue between the government and non government counterparts. The issue as regards

sharing of line listing may also be discussed in depth and may come to a mutual agreement.

Visit to Care and Support Centre under Vihaan project

Oversight Committee visited Care and Support Centre under Vihaan project being run by Bharatpur

network of positive people (SSR) in Bharatpur district. Deputy CMO, Bharatpur, Dr. Manish along with

JD (CST) and AD-BSD accompanied the Oversight Committee to visit CSC.

Team met Project director (Mr. Gajendrer singh) and other staff members (Project Coordinator, Peer

Coordinator, Outreach worker etc) at CSC who explained various services (Counselling, Early linkages to

treatment, tracing LFUs and linkages to social welfare schemes etc).

Project director, CSC highlighted that many PLHIV patients have been linked to with social welfare

schemes with CSC support. So far 476 PLHIV patients have been benefitted through Travel concession

scheme, 97 through Palanhar scheme, 3 through ICDS scheme and around 40 with pension and other

schemes in Bharatpur district. Travel concession scheme related documents were showed to the team. He

also informed about Vishesh Pension Scheme, a state government initiative to allot Rs. 500 to each

PLHIV in the state for which Bharatpur network of positive people was thoroughly engaged in advocacy.

However Supreme Court has currently put a stay on the scheme due to some clarity issues.

One of the Outreach workers mentioned that tracing LFUs in Bharatpur is challenging, firstly due to

insufficient travel allowance to cover difficult terrain of district and secondly due to unavailability of

caste related information of LFU cases without which it is difficult to enquire about them in villages.

Senior Programme Manager under Vihaan Project was also present at the centre. He informed that the SR

(HLFPPT) reports to HIV Alliance every quarter through State Oversight Committee (SOC) meeting

which is also attended by SSRs and officials from RSACS. Critical issues pertaining to the State are

discussed in this meeting. There is also a SSR review cum coordination meeting held half-yearly where

detailed discussions on issues and achievements are conducted.

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Debrief of Oversight Committee activities to Deputy CMO, Bharatpur

Oversight Committee concluded Bharatpur Visit by providing brief of its activities, issues identified

related to programmes, and its recommendations to Deputy CMO of Bharatpur district, Dr. Manish. The

meeting was also attended by Joint Director (CST), Additional Director-BSD from Rajasthan. Following

challenges and recommendations were shared:

1. Hiring and retention of M.O at ART centre is a challenge due to less remuneration being offered for

this position compared to other district M.O positions being funded by state funds. The matter has

been raised at the level of GOI. Oversight Committee advocated to reiterate the issue at state and GoI

level.

2. Issues related to poor coordination and communication between NGO partners (Piramal Swasthya for

AHANA project and MAMTA for Axshya project) under the Global Fund with district health

officials and department were noted. Oversight Committee suggested to devise a quarterly meeting

platform to seek progress update from various NGOs working in the area of HIV and TB at the level

of senior district officials in presence of department heads. It will bring better coordination and

enhanced synergies among various partners.

3. Oversight Committee raised concern of poor nutrition status of MDR-TB patients which can be one

of reasons for poor treatment outcome of such patients. Oversight committee suggested to link MDR-

TB patients with existing state government schemes or nutrition schemes with focus to improve their

nutrition status. Deputy CMO assured that he will take up the matter in district level inter-

departmental meetings to work out solutions.