Implementation of social protection schemes for people living with HIV in three districts of Rajasthan state, India – a mixed methods study

Abstract

Background: In India, public social protection schemes for marginalized populations are extended to people living with HIV (PLHIV) and their households. Care and Support Centres (CSCs) linked to antiretroviral therapy (ART) centres play a key role in linking PLHIV to the schemes. In three districts of Rajasthan, India, we assessed the linkage of PLHIV registered at CSCs (2016–18) to social protection schemes and explored PLHIV and provider perspectives into barriers and suggested solutions for improving linkage. Methods: This was an explanatory mixed method study involving a descriptive quantitative phase using secondary data, followed by a descriptive qualitative phase involving face-to-face in-depth (five PLHIV) and key informant (three CSC staff) interviews. Results: Of 1123 registered PLHIV at CSCs, 1026 (91%) expressed willingness to avail social protection schemes. Of 1026, 94% were linked to any one scheme; 52% to Palanhar, 51% to bus fare concession and 42% to widow pension schemes. The perceived barriers were: authenticating Aadhaar number (unique identification number provided to all Indians using their registered mobile phone number), cumbersome application processes for each scheme, limited utility of travel concession, delayed and/or irregular disbursement of benefits and non-availability of comprehensive information, education and communication material with details of all schemes and their application processes. Reaching out to all PLHIV in the designated district was a huge task for outreach workers. Another important barrier was the potential disclosure of positive status to various stakeholders in order to avail the schemes. Suggested solutions were a single window default application process at ART centres with a smart card and a single pamphlet at ART centres with all the required details. Conclusions: Bus fare concession, Palanhar and widow pension schemes were the most widely accepted and linked schemes by PLHIV. Implementation barriers were identified that need to be addressed to improve the linkage.