Plan Scheme- Best Practice

Financial Assistance Scheme of Delhi Govt for People Living with HIV/AIDS
and Orphan Children Infected or Affected by HIV/AIDS

Background

HIV epidemic brought a terrible toll on children and families worldwide. There are 25 million
orphans in India from all causes, of which approximately two million may be attributed to
HIV/AIDS. National AIDS Control Organization (NACO), Government of India, do not address
care, support of AIDS orphans. Moreover, Delhi is a low HIV prevalent state; hence, the issue of
AIDS orphans never received attention until June 2010 when National Commission for
Protection of Child Rights (NCPCR) referred 5 orphan children infected or affected with
HIV/AIDS to Delhi State AIDS Control Society (DSACS) to ensure their nutritional support.
This was followed by a detailed situational analysis of AIDS orphans infected or affected by
HIV/AIDS in Delhi, constitution of state orphan vulnerable children forum (OVC) with
representatives from Health, DSACS, Social Welfare & Women & Child Department, NACO,
NGOs and International Agencies to address the issues of orphan children infected or affected by
HIV/AIDS.

People Living with HIV/AIDS (PLHIV) including orphan children infected with HIV/AIDS
require Lifelong Anti Retroviral Treatment (ART) and extra nutrition to cope up with their
compromised immune system. They have to travel every month to Anti Retroviral Treatment
(ART) centre to access Anti Retroviral (ARV) treatment. Currently 16038 PLHIV are receiving
ART in Delhi of which 1/3
rd
belong to poor socioeconomic class, unable to meet cost of
transportation to ART Centre and nutrition. In addition, DSACS identified 60 Orphan Children
infected or/ affected by HIV/AIDS live in care of grandparent/ or extended family or institutional
care, in need for support for nutrition & buying education related material and cost of
transportation to health facility. A package of financial support & eligibility criteria was finalized
by OVC forum on the principle of Household Economic Strengthening of PLHIV to improve
quality of life of PLHIV by ensuring adherence to ART.


Package of Financial Assistance

Category Beneficiary Eligibility Criteria Amount of
assistance
/month (Rs.)
Category 1 PLHIV on antiretroviral
treatment in Delhi
(i) Resident of Delhi for last 3 years
(ii) Annual family income should not
exceed Rs. 1.0 lakh
1000/-
Category 2 Orphan children infected with
HIV/AIDS (< 18 yrs age)
(i) Both parents died and at least one of
the parents died of HIV/AIDS
(ii) Child under caregiver or institutional
2050/-

Category 3 Destitute children
infected with HIV in
institutional care (< 18 yrs
age)
Child infected with HIV/AIDS &
initiated ART
2050/-
Category 4 Orphan Children affected Both parents died and at least 1750/-
by HIV/AIDS (<18 yrs age)

This scheme was approved as Plan Scheme of Department of Health & FW, Govt of Delhi under
Major Head 2210, subhead-A1(3)(3)(10) Plan for the FY 2012-13 and rolled out on 1
st
April,
2012 with annual provision of Rs. 1.25 Cr.

Achievements of the Scheme (April 2012 to March 2014)

Category Estimated
Number of
beneficiaries
Amount
sanctioned
per
beneficiary
(Rs.)
No. of beneficiaries
enrolled for the
scheme during April
2012 to March 2014
Expenditure
Incurred
during April
2012 to
March 2014
1 2000 1000 1501 (75%) 213,20,950/-
2 30 2050 14 (47%) 4,81,750/-
3 30 2050 15(50%) 8,11,800/-
4 30 1750 10(33%) 1,85,500/-
Total 2090 1540 (73%) 2,28,00,00/-

SWOT Analysis of the Scheme
1. Strengths of the Scheme
a. Registration of beneficiaries directly at Govt. ART centers where registered in HIV
care and mechanism of cash transfer directly into the bank accounts of the
beneficiary/caregiver by ECS. This would help in checking any possible corruption. On
interview with a sample of 301 beneficiaries conducted in Feb, 2013 it was observed that
all beneficiaries interviewed were getting regular cash transfers into their bank accounts.
b. Only PLHIV on ART (except orphan children infected or affected by HIV/AIDS) are
eligible for the scheme which is likely to enhance ART registration and ARV
adherence with ultimate goal of disease free survival. As reported by 9 Govt ART
centers, 1530 HIV infected beneficiaries of the scheme, except 16 those who eventually
died, are regularly taking anti retroviral treatment.
c. Orphan children living with grandparent or extended families may now not require
institutional care and there will be no sibling separation. Consequent upon roll out of
scheme, an orphan child who was in Institutional care at NAZ Foundation, Delhi was
later moved to care of grandparent looking after another sib preventing sibling separation.
d. The scheme is directly under control of staff working under HIV/AIDS Control Program
already sensitized about the issues of Orphan Children infected or affected by HIV/AIDS;
hence, strengthens the process of socialization in the family and community set up and
reduces fear of being stigmatized. No instance of stigma & discrimination by HIV/AIDS
service providers has been reported.
e. On interview with a sample of 301 beneficiaries in Feb, 2013, it was observed that
financial assistance is being utilized for the beneficiary for travel to ART centre and
buying food items.
f. The process of linkages of cash transfer households with existing government social
welfare schemes to maximize impact have been initiated by setting up a cell at DSACS
to assist these households in preparation of required documents. Eventually 12 widow
beneficiaries of the scheme are also getting benefit of Widow Pension and 5 grandparent
caregivers of orphan children are getting also getting benefit of old age pension.


2. Weaknesses of the scheme & Steps Proposed for its Strengthening
a. Eligibility Criteria of Annual Family Income up to Rs. 1 lakh probably kept some PLHIV
away from getting the benefit of the scheme. The same is being proposed to be amended
to Rs. 3 Lakh / annum.
b. Eligibility criteria for Children Living with HIV/AIDS (CLHIV) of minimum one year
ART to enroll for the scheme probably kept many children away from getting the benefit
of the scheme. WHO has issued new guidelines in 2013 to start ART to all HIV infected
children < 5 years of age, irrespective of CD4 count. Therefore, to ensure adherence to
treatment, it will be essential to enroll all CLHIV for the financial assistance scheme at
the time of initiation of ART. Amendment shall be proposed accordingly.
c. Few caregivers of orphan children infected with HIV/AIDS failed to produce document
confirming death of one the parents due to HIV/AIDS. Since more than 90% of pediatric
HIV infections occur due to mother to child transmission, it is proposed to enroll all
orphan children infected with HIV/AIDS for the scheme irrespective of parental HIV
status, provided documentary evidence of death of both parents is available.
3. Opportunities:
There is opportunity of enhanced ART registration and adherence to ART & reduction in
morbidity and mortality.
4. Threats to the Scheme
Since none of neighboring states of the country have rolled out any financial assistance
package for PLHIV, there is a potential threat of people migrating to Delhi to avail the
dual benefit of ART and financial assistance. Hence, ART centers have been instructed to
confirm residential address of all PLHIV at the time of registration in HIV care. Also,
DSACS has taken initiative and apprised all other State AIDS Control Societies about the
scheme to enable them take appropriate action.

Monitoring of the Scheme

The impact of the scheme in the first two years of its launch has been evaluated through two
indicators:
(a) Diseases free survival- PLHIV are prone to life threatening opportunistic infections like TB,
meningitis, pneumonia, diarrhea, septicemia etc. Regular Anti Retroviral Treatment
significantly reduces deaths among PLHIV. Among beneficiaries of the scheme, only 15
adults and 1 destitute child died, with death rate of 1.1%. As against this, 1336 out of 7248
patients not eligible for the financial assistance scheme on basis of financial criteria died with
death rate of 18.4%.
(b) Adherence to ART- As per NACO, GOI guidelines all PLHIV eligible for ART on basis of
WHO clinical staging (III, IV) and /or CD4 count (< 350 cells/cu.mm) are initiated lifelong
ART. If adherence to anti retroviral treatment (ART) is below 95%, it may result in treatment
failure and need for costly & potentially toxic second line ART. Among beneficiaries of the
scheme adherence to ART was 100% as against 88% among other patients not eligible for
the financial assistance scheme.

Other Initiatives of Delhi Govt for Care, Support of PLHIV
1. Grievance Redressal Committee under Chairmanship of Secy (H&FW) addresses grievances
of PLHIV by holding quarterly meetings regularly
2. Free tests for PLHIV like MRI, CT scan, ultrasound, blood and other tests in Delhi Govt
Hospitals
3. Provision of blood / blood products free of processing fees and without any need for
replacement donation if required for PLHIV













































Impact of Monthly Cash Transfers to PLHIV on Adherence to Anti Retroviral Treatment