“For any health program to be successful, we need community participation. It can lead to an organic change that can last a long time,” advised Mr. J V R Prasada Rao, Former Health Secretary, Government of India, and Former Special Envoy to UN Secretary-General. “This community participation is lacking in the COVID response today, which is completely government-driven without any community involvement.”
Mr. Rao was speaking at the third book talk organized by SVKM’s NMIMS on 16th April 2021, about his book, Celebrating Small Victories, My Journey Through Two Decades of AIDS Response. He shared invaluable insights from his groundbreaking work on AIDS eradication in India, as the former director of the National AIDS Control Program and later in UNAIDS, the Joint UN programme for the Asia Pacific region, kickstarting an engaging discussion on strategic information, epidemic response, strategy innovations and targeted interventions. The discussion panel was moderated by Dr. Meena Chintamaneni, Registrar, NMIMS, and Dr. Sudhakar Kurapati, Former Senior Advisor to U.S. Centers for Disease Control and Prevention (CDC). Among the attendees was Dr. Ramesh Bhat, Vice Chancellor, NMIMS Deemed to-be University.
Drawing a comparison between the COVID-19 and AIDS responses, he pointed out the key difference in the approach towards involving communities. “For the AIDS control program, we started with involving the vulnerable sections of the population - sex workers, their children, people who inject drugs, and the LGBTQ+ community. The program was community-driven and community-owned, where these groups were equal partners with the government. We picked officers who had the same orientation and we posted NGO advisors within the government. It was among the first few programs where the funding was directly routed to the NGOs and activists working in the area.”
“This time we started off right with strong leadership, but neglected people’s participation. People who are actually implementing COVID control are government workers, health workers, police, Home Guards, and municipal workers. In isolated cases where the local community was involved, such as in Dharavi (Mumbai), we saw excellent results. But overall, there is a lack of community intervention. Involving the local people would have lessened the burden on the government and we may have seen a more seamless response during the second phase.”
He provided a glimpse into India’s progress in AIDS prevention and control through anecdotes and lessons he had learned while steering the Indian Government’s response during his two-decade-long tenure in India and later in UNAIDS. Other than community participation, one of the key lessons he learned was the importance of strategic information and its dissemination.
“When we started in 1997 there was almost no data apart from some civil service studies by ICMR. So we organized the first time national- and regional-level surveillance, within a gap of 2-3 years, of AIDS in India, with astounding results. We found that 2% of the population is always infected with HIV in the Southern and North-Eastern states of India, and 70% of drug users in Manipur were already HIV positive. These shocking results helped us to motivate the political leadership. For instance, Chandrababu Naidu, who was the Chief Minister of Andhra Pradesh at that time, was shaken at seeing that 12% of men in the state go for multi-partner sex outside marriage. It spurred him to take action, motivating collectors. As a result, we saw an impressive turnaround within a year.”
The lack of information dissemination was another difference he saw in the current COVID response, especially in estimated numbers. The discussion ended with an insightful dialogue on government outlays in public health, community education, integration of AIDS in public health programs, removing the stigma around vulnerable communities, universal healthcare, the role of social media in disseminating information, and community empowerment.