Public-Private Partnerships in HIV Care and Support in India
Corporate groups & public sector companies set up HIV counseling and testing centers and Anti Retroviral Treatment centers in partnership with government.
“My hope for life has increased,” says Ram Kumar, a Mumbai Port Trust (MbPT) employee who is living with HIV.
Ram Kumar is one of 195 employees who are getting antiretroviral therapy (ART) from the company, as part of its policy to take care of staff and their families.
a) PPP for integrated counselling and testing centres
i) Mumbai Port Trust (MbPT)
MbPT is an autonomous body under the Ministry of Shipping, Road Transport and Highways. It has access to a population of 200 000 made up of 20 000 employees and their dependants together with 35 000 retired employees and their spouses. Based in Mumbai, a city with high HIV prevalence, MbPT was one of the first companies in India to provide care and support to its HIV-positive employees way back in 1999. The company began providing second line ART in 2002. MbPT has a comprehensive workplace programme, including a workplace policy, developed with assistance from the Mumbai District AIDS Control Society (MDACS) and the ILO. A cadre of master trainers for HIV has been developed in the MbPT.
“Creating awareness about HIV and disseminating our policy helps. We want to protect our people and don’t want to increase the number of infected employees. We already have quite a few to whom we are providing treatment,” says Elize D’Silva, Health Officer, MbPT, who is one of the master trainers in the organization and conducts regular sessions.
Between October 2006 and July 2009 more than 7000 people were tested at the centre. One hundred MbPT employees have tested positive (65 men and 35 women). The prevention efforts of MbPT seem to be making an impact. From December 2008 up to June 2009, none of the employees tested have been HIV-positive.
ii) The Central Coalfield Limited (CCL),
The CCL in Ranchi is a subsidiary of Coal India Limited and has set up a partnership with the Jharkhand State AIDS Control Society (JSACS) to provide HIV workplace interventions. CCL has a workforce of nearly 60 000, spread across a large mining area.
The CCL developed its workplace policy and programme in collaboration with the ILO, using the ILO Code of Practice on HIV/AIDS and the World of Work. In 2007, CCL collaborated with JSACS to set up a network of Integrated testing and counseling centers (ICTC) within the company’s existing hospitals.
The ICTC facilities of CCL are open to everyone, not just company employees, in order to enhance access to HIV testing and counseling services.
iii) Jubilant Organosys Limited (JOL)
JOL is a pharmaceutical industry company that has also set up ICTCs at its units in Nanjangud (Karnataka State) and Gajrola (Uttar Pradesh State).
The initiative stems from a commitment by the management. “Jubilant, as a responsible corporate citizen, is committed to play its contributory role in the HIV awareness and prevention programmes,” says Shyam Bang, Executive Director of JOL.
The facility at Nanjangud, Karnataka is only for the employees and is run completely by the company, while the one at Gajrola was set up in collaboration with Uttar Pradesh State AIDS Control Society (UPSACS).
The ICTC at Gajrola was set up in March 2009 in partnership with the UPSACS as a result of the company’s successful TB treatment programme, and also because of its involvement with the ILO’s HIV workplace programme.
The company pays the costs of a doctor, a laboratory technician and a counsellor, while UPSACS provides training, testing kits and condoms. Although this is a recent initiative, 19 people have been referred for testing to date and three have tested positive. JOL is working to increase the uptake of ICTC services by creating awareness through the company’s HIV master trainers.
b) PPP for enhancing access to treatment: setting up antiretroviral therapy centres
“I am one of the first who came to the Ballarpur ART centre. Earlier I used to go to the Nagpur centre which is 150 km away from my place. This is a big help. Thanks to BILT for setting it up here,” says Priya Devi).
BILT set up the centre in partnership with the National AIDS Control Organization (NACO) and the Confederation of Indian Industry (CII) with support from the Global Fund to Fight AIDS, Tuberculosis and Malaria.(GFATM).
BILT is a paper manufacturing company operating in six locations across India with a workforce of more than 10 000. “BILT has a comprehensive anti-HIV programme, which has affected over 60 000 lives. BILT’s ART centre at Ballarpur, Maharashtra, is nationally and internationally recognized as a pioneering effort to tackle the threat of HIV at the community level,” says R.R. Vederah, Managing Director of BILT.
The company is creating an enabling environment to overcome this situation by doing regular sessions with employees and disseminating its HIV/AIDS workplace policy in collaboration with the ILO. The Ballarpur ART centre also provides CD4 testing for the government ART centre at Chandrapur and Gadchiroli in Maharashtra.
BILT’s experience has been quite positive and the staff working in the ART centers are very enthusiastic. “Working in the ART centre has been a very enriching experience, I feel very happy when I help so many patients.” Says one of the nodal officers of BILT.
- Workplace programmes are a good entry point for PPP.
- It is important to have an interface agency that can provide a neutral platform for brokering partnerships and creating mutual trust between partners.
- Public sector companies like MbPT and CCL, who have existing large medical/occupational health and safety set ups, can incorporate ICTC and ART centres in partnerships with their respective State AIDS Control Society. These models have a huge potential for scaling up the national programme.
- The private sector can help to increase access to services under the PPP model. The models of private companies like Jubliant and BILT can be replicated.
- Initially employees may hesitate to access ICTC/ART services at the company facility. An enabling environment needs to be created for which the effective dissemination of HIV workplace policy and regular awareness efforts are necessary.
- ICTC and ART centres, set up by companies (whether public or private), should be open to the wider community, but this requires a planned effort to raise awareness about the facility. Partnerships with local NGOs and networks of people living with HIV can be very useful here.
- PPP for HIV care and support provides opportunities for HIV counselling, testing and treatment to contract workers and migrant labourers who work with industries.
A documentation of Good Practices:
Prevention of HIV/AIDS in the World of Work: A Tripartite Response