ART centres in Uttarakhand: Some reflections from the field: By Supriya


One of the Millennium Development Goals (MDG) is to control the spread of HIV/AIDS. This puts a continuing concern on improving health services. Many projects are run by the government to address these concerns effectually. One such program is operation of ICTCs/STIs/ART centres in government hospitals. These centres have been successful in providing pre and post test counselling through trained counsellors to the individual/s coming for HIV screening. However, there are many challenges and barriers faced at bot  Institution (Hospitals and Health workers) and community level (community members).


Poor infrastructure and facilities

A standard approved size room is given to counsellors for their work. However, at some of the ICTCs/STIs the counsellors are facing troubles in carrying out their work in the given space. The problems range from room given at one far end of the building, electricity/store room being converted into counselling room, room given at first/higher floors, absence of proper waiting area outside the counseling room etc. This could be taken care if room is allotted after making sure it is easily accessible, comfortable as well as guards the privacy of visitor.

The counsellors at almost all the ICTCs/STIs have to bear the burden of administrative issues. These range from low salary amount, delayed salary payments, petty politics at the workplace (at some centres), absence/delayed supply of essential work material like Kits for STI counselling. These problems could result in burnout of counsellor. Hence the concerned authorities should maintain the SOP strictly so as to enable counsellors to do their work effectively. Apart from these, often the counsellors have deal with the interference and pressure from local authorities (local leader/s, group/s etc.) in their work.

In the state of Uttarakhand, in the areas at great altitude most of the ICTCs/STIs counsellors have less patient’s visits. This is mainly due to absence of specialist doctors and specialised services in the hospitals at these places. The provision of these would mean more patients visiting the centre.

Capacity building for counsellors

The minimum qualification for counsellor’s job is bachelor’s degree. Hence some counsellors are neither from psychology/sociology/social work background, nor received any training in counselling. Some of them lack even the basic skills of counselling. This could be addressed by making either the aforesaid subjects or a training/experience of counselling compulsory for applying for the post. The newly appointed counsellors should be allotted centres only once they have completed induction training. In Indian society HIV/AIDS is still considered to be a taboo issue. Though the counselors are trained, some of them have their own prejudice. Often they are not sensitive and have indifferent attitude towards the sero-positive individuals. This could lead to patients getting discouraged about coming for treatment. Hence, providing trainings to sensitize health workers is utmost importance for success.

Governance issues

The sero –positive patients could avail ART medicines from the Link ART centres. However, their number is less in Uttarakhand, so more number of such centres would be beneficial for community as this would provide access to necessary medicines to the concerned person without many troubles. Patient load is high at some centres, which results in limited counselling period so taking up significant points can make session effective. Additional workload like filling of many formats daily apart from report to be submitted to concerned authorities is another issue, which could be dealt promptly with following proper work plan.

Need for community care centres

Distance is one major problem, which restricts people from accessing the health facilities. Finance is another issue which requires attention. Most of the people are poor in terms of finance hence lack both money and time (since they could utilize that time for work) to visit the facilities until their health issue becomes dead serious. Promoting NGOs/local groups to work would help people like providing vehicle support for reaching health facility

The community care centre (CCC) for sero-positive patients is not present at local levels hence a sero-positive individual who is at Srinagar in the state has to come down to Dehradun to avail the service. Also availability of seats at such centre is another issue.

Improving awareness in the community

HIV/AIDS is still a taboo subject, so there is a hesitation among community members to seek help like visiting health facilities for fear of character judgement or being out casted from community. There is absence/lack of complete and correct information on the subject. This results in people believing in many myths and misconceptions and often not approaching health facility for timely treatment. All this could be successfully answered by sensitizing community on the subject. This could be done through awareness campaigns, street plays, informative wall paintings etc. Involvement of community head and Panchayat members would also prove to be fruitful.

Supriya Chand  was a  student of e-learning course in Public Health Management(ePHM) conducted by Institute of Public Health, Bangalore, India.

Disclaimer: IPH blogs provide a platform for ePHM students to share their reflections on different public health topics. The views expressed here are solely those of the authors and not necessarily represent the views of IPH.