Transitioning Services

De-verticalizing polio, AIDS and TB programmes and transitioning WHO service delivery components in them to regular government structures run by district, state and central authorities, as the public health system of India now has more than sufficient knowledge, organizational capacity, resources and service delivery mechanisms.

In fact, all the improvements proposed under Strategic Priorities 1 and 2 in the field of financing, regulation, governance, access to medicines, strengthened surveillance, monitoring and evaluation and research, will face their acid test in the fight against the combination of CDs and NCDs in the next decade. No doubt, however, that management of AIDS and TB and the efforts for certified eradication of polio, will remain a major issue for India for a number of years to come. Sustaining results in these areas now requires a gradual, phased “transfer strategy” of WHO services to the national, state and local authorities with the sine qua non condition that no erosion of effectiveness occurs during the transition period. Such transition strategy will be developed through a consultative process.

Both the Government of India and WHO want to see more emphasis being placed on augmenting a healthy public policy combined with the much needed cross-sectional services for tackling diseases through the continuum of care. Population services (including improvement of dietary habits, promoting patient self-management, implementation of no-tobacco rules, public health inspection services which are critical for fighting food-borne and water-borne diseases, and laboratory support for STI diagnosis) need to be scaled up and the same applies to preventative primary health care interventions, combined in turn with effective emergency and regular services as well as highly complex individual/personal services. Once more, a gender-related balance will be paramount here.

In summary, WHO’s service delivery in polio, AIDS and TB has to continue for as long as necessary according to country needs, but it should take into account the lessons learnt and have exit in mind. A shift from focusing on polio to routine immunization, for example, in the context of maintaining polio-free status and achieving 90% reduction in measles mortality (baseline 2000) by 2013 has to be accompanied by a timetable for transferring WHO work to the government authorities at all levels. The same applies to relevant objectives in the case of TB (e.g. integration with general health systems, with emphasis on access to drug-resistant TB diagnosis and treatment, integrated TB/HIV services, and improving the engagement of all care providers).

In the case of AIDS, technical and normative support needs to continue, including operational guidelines for integrating health service elements, such as quality assurance of clinical services, ensuring long-term retention of patients on antiretroviral therapy, preventing parent-to-child transmission within the NRHM, updating antiretroviral therapy to consolidate the progress achieved in the last six years and strengthening linkages with community services, monitoring of the development of HIV drug resistance, and reducing HIV transmission among members of the most-at-risk population. At the same time, the above priority services should be increasingly incorporated under regular service schemes linked to universal coverage and delivered by well trained staff and properly licensed facilities.

In the coming six years WHO will maintain its technical support while increasingly focusing on policy advice and strategic work.