Covering Treatment for HIV and AIDS in India: A Feasibility Study30 Dec 2006
The need for coverage or insurance for art takes on greater urgency given the economic status of the majority of the detected cases of HIV/AIDS in India.
Despite falling prices of anti-retroviral (ARV) drugs, the expenses involved for individuals and families living with HIV/AIDS who need to be on ARV therapy (ART) continue to be high enough to impose serious economic hardships on individuals and families which act as major deterrents to accessing such treatment. Th e need for coverage or insurance for ART takes on greater urgency given the economic status of the majority of the detected cases of HIV/AIDS in India; while no fi rm data is available, evidence from the handful of care and support organisations (CSOs) around the country indicates that most of their clients are in urgent need of fi nancial help if they are to access ART. Th e only individuals who are currently covered by insurance for ART are: Central Government employees through the Central Government Health Scheme (CGHS); employees covered under Employees State Insurance Scheme (ESIS); employees of the Railways and the Armed Forces; and employees of various other public sector undertakings.
While insurance for ART can be also off ered by private insurance companies and eff orts are being made to get some of these companies to incorporate coverage for HIV/AIDS treatment (Gupta et al, Population Council 2004) – these amended insurance products will continue to be out of reach for the bulk of those seeking treatment unless ways can be found to pay part or all of the premium on their behalf.
Recently the Government of India announced a scheme that would give free ARV drugs to selected HIV-positive individuals, including children and pregnant mothers. Th e free ARV programme has been implemented since April 2004 in six high-prevalence states. It is planned that the number of ART centres will be increased to 25 and cover a total of 25,000 patients by the end of 2004-05 and that ART facilities will be extended to 1,00,000 patients by the end of 2007. Th is raises the question as to whether there is still a need for nongovernmental schemes to cover ARV treatment. Th e key factor that will separate the government initiative from schemes implemented by CSOs is the quality of care and treatment off ered. Free drugs are only a small part of the picture; quality of care and treatment with maximum adherence is the key. While no study exists that has evaluated the government’s free ART initiative, anecdotal evidence does indicate that there are some issues regarding the quality and management of the programme. Th is means that at present if an organisation can ensure that its clients get quality care with followup under a programme of coverage for ART, it would make the programme superior to the current government initiative. Thus an essential element in the design of a nongovernmental scheme would be putting in place an operationally feasible set-up of HIV/ AIDS-related healthcare services, which would include trained healthcare providers, availability of ARV drugs, medicines and tests, and other required infrastructure.
The urgent need to find ways to cover treatment for individuals trying to access ART has prompted the UNDP, Delhi, to initiate a study to explore potential schemes that can be piloted in order to test their financial and operational feasibility. Freedom Foundation (FF), a Care and Support Organisation (CSO) based in Bangalore and with widespread and extensive experience in the provision of ART to the general population, was used as a case study to conduct the feasibility exercise. The Health Policy Research Unit (HPRU) of the Institute of Economic Growth, an economic research think-tank based in Delhi, was commissioned to conduct the study. This report was prepared by the HPRU team in close collaboration and consultation with the FF and UNDP, Delhi.