`The project is a tremendous success'

Interview with Dr. N.S. Murali, honorary secretary, VHS.

Dr. N.S. Murali, honorary secretary, Voluntary Health Services Hospital, which runs the AIDS Prevention and Control Project, spoke to Asha Krishnakumar about the philosophy of VHS, the reasons for APAC's success and its future plans.

Excerpts from the interview:

Why did USAID choose VHS for its HIV/AIDS prevention effort in Tamil Nadu?

VHS is a unique experiment in health care delivery. It is /primarily aimed at the poor. It is the brainchild of Dr. K.S. Sanjeevi whose birth centenary falls this year. The main aim of VHS is to improve the community's health activity and to promote its health-seeking behaviour.

First, Dr. Sanjeevi started for the poor a family health insurance scheme that emphasised preventive health care as against curative health care, which, until then, was the norm. It was supported by a group of people including Kasturi Srinivasan of The Hindu and M.A. Chidambaram [founder-Chairman of SPIC].

Then Dr. Sanjeevi set up mini-health centres for every 5,000 people in the rural areas. An educated woman was selected to be the health worker in each centre and the people were given health orientation, nutritional support, and so on, with VHS as the main referral hospital.

Impressed with VHS' community health movement, USAID approached us in 1991 to take up its HIV/AIDS awareness generation programme in Tamil Nadu. Despite our initial reluctance, we took up the AIDS Prevention and Control Project (APAC) as it dovetailed with our own philosophy of reaching out to the needy and improving the health of the community. The project is a tremendous success.

What are the reasons for APAC's success?

APAC-VHS carefully selected about 50 NGOs (non-governmental organisations) in the rural areas and worked in close coordination with them. We followed a very rigid selection and monitoring criteria for the NGOs. Another significant reason for APAC's success is its excellent team, with very little staff turnover, and a carefully selected group of dedicated consultants. A well-planned system of financial management is another reason. We were also able to take all the NGOs with us to the satisfaction of both VHS and the funding agency.

We are, perhaps, the only voluntary agency to have a full-fledged in-patient service ward with a 24-bed facility for people living with HIV/AIDS (PLHA). This we run with YRG Care (Y.R. Gaitonde Centre for AIDS Research and Education).

How has APAC's efforts been recognised?

Significant is the spread of awareness of HIV/AIDS in the State, which is clear from our surveys.

Also, at the completion of seven years of the project, a USAID expert team from Washington evaluated it and gave excellent reviews, based on which the project has been extended until 2007.

The National AIDS Control Organisation (NACO) has selected APAC to lead its Technical Research Group on targeted interventions and has asked APAC to share its experience with other States.

Based on APAC's reputation, the Bill and Melinda Gates Foundation approached VHS to take up its HIV/AIDS prevention programme in Tamil Nadu. It gave us $30 million for five years. The unique feature of the project is that for the first time in the country funds were given directly to VHS and not through the government.

This project, covering commercial sex workers (women in prostitution and men having sex with men), was started six months ago in VHS under a separate secretariat called the Tamil Nadu AIDS Initiative (TNAI). This is working in 11 districts where APAC and Tamil Nadu State AIDS Control Society (TNSACS) are not present. This programme also runs 32 STD (sexually transmitted disease) clinics, where drugs are also provided.

What are your plans for the second phase of the APAC project?

We have extended our programme to include groups such as industrial workers and men having sex with men. Apart from prevention efforts, we are focussing on care and support at the community level. We have also extended our jurisdiction to cover Pondicherry. In the extended programme we now work with 72 NGOs.