Pharmacy Product >> Health Topics >> Site Map >> District AIDS Prevention

District AIDS Prevention and Control Unit in 26, category “A” Districts of Karnataka

Background and Rationale
 
Under NACP-III, the District AIDS Prevention & Control Units (DAPCUs) will be established in each A and B category district. They will be the main hub for mainstreaming and convergence of HIV/AIDS activities and other preventive and curative services of the Department of Health & Family Welfare Services in the District. Activities planned by the Karnataka State AIDS Prevention Society would be effectively implemented, supervised, monitored & evaluated at the District and sub-district levels by DAPCUs. In Karnataka, it is envisaged by integrating activities and services of KSAPS with that of NRHM, Karnataka Health Systems Development & Reforms Project (KHSDRP) and the Department of Health & Family Welfare Services.

Based on the HIV Sentinel Surveillance (HSS) conducted in 2006 by NACO, all the 116 Districts located in 28 States in India, have been categorized into A, B, C & D Districts based on their Antenatal/ PPTCT prevalence in their sentinel sites the past 3 years.  Karnataka is one of the 6 High Prevalence States in the country. Post Sentinel Surveillance conducted 2004- 2006, Karnataka had 26 Districts, categorized as “A” Districts and 1 District in the “C” category. This scenario therefore, calls for a district by district response. Towards this endeavour, the State will plan to strategize and focus on micro- issues as well to significantly enhance the performance of the Districts. 

For the same, DAPCUs has been envisioned in each of the A districts of Karnataka to lead the HIV AIDS initiatives the State and their role in mainstreaming HIV/AIDS activities in the Districts would assume a very significant role in the implementation of NACP-III. 

Proposed Structure of DAPCU:

The District Health & Family Welfare Officer (DHO) who is the overall Head of all the Public Health Programs of the Department of Health & Family Welfare Services at the district level will also be overall in-charge of the DAPCU. He will be appraised by District HIV AIDS Program Officer on their performance on a month to month basis.

Within Karnataka, through a Government Order, functions of KHSDRP and NRHM has been merged together and both the department works will now be headed by District Project Management Officer (DPMO).

The District Project Management Officer (DPMO) who is the Head of the District Project Management Unit (DPMU) established under KHSDRP has been reporting to the District Health & Family Welfare Officer and furnishing data and information on all the Programs except HIV/AIDS as the District TB Officer was also the HIV/AIDS Nodal Officer in the District. It is now proposed that an Officer exclusively responsible for all activities of HIV/AIDS in the District and who will be called the District HIV/AIDS Program Officer (DHAPO), and will closely work with DPMO. This will help integrate and mainstream the objectives of the RCH activities under NRHM, KHSDRP and other National Programs especially TB Program with that of HIV/AIDS Program under NACP-III.

DHAPO will be of the Cadre of Sr. Specialist (who has served more than 13 yrs in the DH&FWS will be redeployed/ deputed. He will be supported by 2 Assistants and 1 M& E Asst who will be the only 3 staff that will be recruited by KSAPS for DAPCU. The District Project Manager (DPM) who is currently assisting the DPMO will henceforth also work closely with the DHAPO in coordinating activities and services of the HIV/AIDS Program.

The Support staff now working under KHSDRP and that of NRHM who have been listed below will henceforth jointly undertake responsibilities entrusted by the DHAPO and his staff as part of their job responsibilities in addition to 3 staff that would be recruited by KSAPS for undertaking activities of HIV/AIDS Programme under NACP-III.
   
Staff recruited by KHSDRP and NRHM :               Staff to be recruited by KSAPS:

   i)         District Project Manager                 
i)                    Office Superintendent                               ii.  M & E Asst
ii)                   FDA                                                         iii.   Asst
iii)                 Typist                                                        iv.  Asst
iv)                 Accounts Assistant                        
v)                   Data Entry Asst                                                                             
vi)                 Group-D
vii)                Vehicles-2
viii)              Drivers-2

    
Roles and Responsibilities of DAPCU

Key functions of DAPCU would be to Develop District Implementation Plan, implement and monitor components of implementation plans, forge partnership with Civil Society and create an enabling environment.
They will undertake the following activities under the various Programs
  
Under TI Program

Ø       Facilitate access to AIDS prevention and treatment services, general health services and other entitlements
Ø       Create a supportive environment for TIs to functions

Women, Children and young adults

Ø       Working with District level Departments for prevention, treatment and impact mitigation on women, children and adolescents

Migrants Trafficked persons & their populations in cross border areas

Ø       Provide pre departure guidance to migrants and provide linkages to organizations in destination areas

HIV/AIDS Response in Work place:

Ø       Facilitate access to treatment and prevention services for referrals from interventions

Package of services:

Ø       Monitor the delivery of services
Ø        Integration of services with the general Health systems and other non Health interventions
Ø       Collect and forward samples for EQAS

Assure Safe Blood and Blood Products:

Ø       Develop a District wise information and transportation scheme to provide blood and blood components to Blood Storage Centres
Ø       Systematize voluntary blood donation
Ø       Deal with infrastructure issues of new blood banks
Ø       Monitor disposal of Hospital waste

Condom Programming:

Ø       Monitor availability of condoms at service provision points

Communication & Social Mobilization:

Ø       Conduct District level IEC Campaign
Ø       Use local channels for demand generation
Ø       Work with Panchayat Raj Institutions (PRI) and local CSOs for social mobilization for HIV prevention and management

Mainstreaming with Public and Private Sector:

Ø       Technical Support to District level Organisations to integrate HIV in their functions
Ø       Provide linkages to HIV services in the District departments and Organisations

Convergence with RCH, TB and other National Programmes of MOH&FW:

Ø       Work with the concerned Programme Officers to effectively integrate their functions

Capacity Building:

Ø       Facilitate all HIV/AIDS Training Programmes planned under NACP-III in the District
Ø       Impart/arrange resource persons from the District for training
Ø       Evaluate Training Programmes conducted under NACP-III in the Districts

Civil society Partnerships forum at National, State and District levels

Ø       Support the formation and functioning of district Civil Society partners forum

Improved access to treatment for Opportunistic Infections (OIs) and continuum

Ø       Monitor the management of OIs

Increasing the number of PLHA on antiretroviral drugs

Ø       Follow-up PLHA, CLHA and ANCs  through DLN whose CD4 have been estimated and eligible for ART

Providing care & support and treatment for CLHA & OVC

Ø       Monitor children born to sero positive mothers for early signs  HIV and the need for ART
Ø       Monitor and investigate any instance of denial of rights to CLHA and OVC
Ø       Advocate with District authorities and organizations to protect the rights of children

Ensuring quality of ART Services:

Ø       To ensure that ART services provided both in the public and private sectors are of the desired standard
Ø       DLN to also be part of this activity

Management of ART Drug Resistance:

Ø       Arrange for transportation of samples
Ø       Ensure that the Guidelines on ART are disseminated to ART Centres

Innovative Funding of ART Drugs:

Ø       Identify willing philanthropists for funding ART Drugs

Strengthening community care & support Programmes

Ø       Establish referral linkages to service providers
Ø       Monitor functioning the approved centers

Linking care, support and treatment with prevention
Ø       Monitor integration

Impact Mitigation
Ø       Set up linkages with District level Organizations and Departments for support to PLHA  and their families
Ø       Facilitate access of PLHA to social support

Monitoring Systems:
Ø       Develop a Monthly plan of action to monitor all activities of the HIV/AIDS Programme under NACP-III

Evaluation:

Ø       Ensure that the data that is generated at each of the service delivery points for PLHA are of the desired quality and all best practices, protocols and guidelines are being adopted.
Ø       Prepare a plan for validation of data generated at all service points in the District
Ø       Assist in all evaluation activities of HIV/AIDS programs being conducted in the Districts and ensure that the CMIS reports are sent from DAPCU to the KSAPS M & E Wing.

Costing

Under the stewardship of the District Health & Family Welfare Officer (DH &FWO) in the District, the District AIDS Prevention & Control Unit (DAPCU) will function with co-ordination, support from the existing structure of the Department of Health & Family Welfare Services, NRHM (National Rural Health Mission), KHSDRP (Karnataka Health Systems Development & Reforms Project) and KSAPS. 

Details of staff of DAPCU have been mentioned in the table 1.0

There would be Cost-sharing between all the above, towards staff salaries /allowances / travel and Office expenses.

Table: 1.0: Cost towards Salaries under D H & FW S, KHSDRP, NRHM & KSAPS

 ii) # NRHM’s Cost-sharing:  In Sl. Nos. 4, 8, 9 & 13 works out to be Rs. 60,000/- per month & an annual cost of Rs. 7, 20,000/- (Rs. Seven lakhs twenty thousand only)
 iii) KSDRP’s cost sharing: in Sl. Nos. 2, 5, 6, 7, 13 & 14 works out to be Rs. 72,500/- per month and annual cost of Rs.8,70,000/-
iv) Department of Health & Family Welfare Services, Govt. of Karnataka Cost –sharing: for DAPCUs is  in Sl. Nos. 1 & 2 which is Rs. 55,000/- per DAPCU  and at an annual cost of Rs. 6,60,000/- ( Six lakhs, sixty thousand only)

Salaries would be met from the above mentioned Project Funds and the Department of Health & Family Welfare Services. Roles, responsibilities and job profiles though specific in the respective Projects would now encompass HIV/AIDS activities in the District. Hence sharing of roles/responsibilities of HIV/AIDS as well as lending supportive supervision would vest with  5  Key Officers in the DAPCU viz. District Health & Family Welfare Officer, District RCH Officer, District Project Management Officer, District Project Officer and the District Project Manager.

Sharing of roles/responsibilities as well as supportive supervision would vest with 5  Key Officers viz. District Health & Family Welfare Officer, District RCH Officer, District Project Management Officer, District Project Officer and the District Project Manager their unified action for the success of DAPCU.
  
TSU model at district level
In addition to the support from NACO for DAPCU, support for 10 DAPCUs is sought from other non Government sources primarily through development funders to act as the district TSU for the DAPCU. The TSU model will function under the overall administration of the local governance. Two organizations have expressed interest namely KHPT and MYRADA. Under TSU model, it is proposed that TSU costs within DAPCU would be picked up by the funding agencies. This will help improve DAPCU performance and will throw up learning models for the state.

Conclusion
DAPCU will form the focal point of HIV AIDS interventions in the district. They will work within the overall frame work of health initiative in the district. They will bring together and work in close coordination with all the other health initiatives in the district and will form strong working synergies with all the other health initiatives. PPP model is proposed as it will enrich the DAPCU concept and bring in more partners from whose knowledge and experience the state will benefit.

In the first year DAPCU will be started in all 26 A districts of Karnataka. Total cost for DAPCU will be Rs. 161.9 Lakh

Total trainig cost for DAPCU is Rs. 12Lakh

QUERY: District AIDS Prevention Control Unit (DAPCU) and the National Rural Health Mission (NRHM) - Experiences. REPLY BY 1 July 2009

The NACP-III aims at integration of HIV interventions in the NRHM framework for optimization of scarce resources and provision of seamless integrated health services. Moreover, NACP-III aims at ensuring long-term sustainability of interventions. Thus, setting up of DAPCU within the District Health Society, sharing administrative and financial structure of NRHM becomes a crucial programme strategy for NACP-III.

At www.nacoonline.org/upload/guidelines/DAPCU%20OG.doc are the operational guidelines for DAPCU. This document states that the DAPCU will ensure implementation and supervision of ongoing NACP-III activities related to care and treatment, and further facilitate civil society partnership at the district with NGOs, CBOs, Red Ribbon Clubs, PLHIV network, private sector organization and academic institutions working in the area of HIV in the district. Simultaneously, it will attempt to create a wider knowledge base in the district for effective prevention, detection, referrals and treatment strategies through convergence with the ongoing interventions of NRHM, RCH, and TB Control.  In addition, building a strong monitoring and evaluation system through the public health infrastructure in the district is on the anvil.

The success of the national response to HIV depends on the effect of HIV intervention programmes at the grass root level. Therefore, I would like to know from members of the AIDS Community their experiences with DAPCU. Specifically, as NACO would like to replicate the DAPCU initially in all the high prevalent states, we would like to know:
·         The legal, institutional, and procedural issues in setting up, as well as challenges faced in making the DAPCU functional,
·         What are the problems involved in manning the DAPCU, building their capacities, and delegation of administrative and financial powers,
·         The relationship with DM or Collector and District health society, their relationship with SACS and NACO,
·         Are the present guidelines prepared taking into account the existing institutional arrangements or does it require modifications?
·         What are the examples of integrated public health services that the DAPCU can follow to integrate NRHM, RCH and TB Control services with HIV prevention and Care?
·         What are the challenges faced in extracting, reporting and analyzing the data at the DAPCU level?

Thanking you in advance for sharing your experiences,

Alankar Malviya,
UNAIDS India Office,
New Delhi.