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**PHN 1992 Sector Review**

empathy with which those services are delivered. Two initiatives undertaken during FY92 address the issue of quality in much more depth than the typical PHN activity and are highlighted here for the consideration others.

# _1. India AIDS Project_

4.16 The government of India has stated its unequivocal support for the policy of humane treatment of persons affected by HIV/AIDS, as articulated in Resolution WHA41.24 of the World Health Assembly. This decision is in recognition that programs for the prevention and control of AIDS should be planned and implemented in a manner that ensures the humane treatment of affected persons, which is an essential prerequisite for an effective long-term policy for the prevention and control of AIDS. Accordingly, the India AIDS project would assist the government in creating a framework for the provision of health, psychological and social support to HIVinfected persons and AIDS patients. The aim would be to: foster the spirit of understanding and compassion for HIV-infected persons; protect the rights and dignity of HIV-infected persons; avoid discriminatory action against and stigmatization of HIV-infected persons; ensure the confidentiality of HIV test results and case reports; and promote the availability of social services including confidential counseling.

4.17 Counseling services would be available to the affected individuals and their families on their request and would not be imposed on them. The purpose of counseling support for persons with HIV and AIDS would be to : offer explanation and help get the individual to understand the significance of having HIV or AIDS, motivate the infected individual to minimize the risk of transmitting the infection through the use of condoms, and assist in meeting the psychosocial needs of the individual and his/her family, including guidance on lifestyle, adjustment and maintenance of good health for as long as possible. The govemment has established

**a** Technical Advisory Subcommittee on Social, Ethical and Legal Issues, which will put in place and monitor the operation of effective procedures through which affected persons can express grievances and seek resolution of concerns.

4.18 This concept could be applied in other PHN programs as they impinge so intimately on the personal choices, values and lives of individuals, households and communities. Evaluating and addressing quality of services on technical grounds alone will not ensure that services will be valued by clients.

# 2. _Sector Report on Quality of Health Care in C6te d'Ivoire_

4.19 Both the approach to the subject matter as well as the subject matter, itself, are unique features of this piece of sector work. Rather than the Bank taking the lead in addressing this topic, some aspects of which are subjective and cultturally charged, a national team was assembled to assess quality of services in Cote d'Ivoire. This team visited a large number of facilities throughout the country and observed and assessed the quality of care provided at every level of service. The findings of this study are thoughtprovoking and highly attuned to the cultural context, revealing important and pervasive deficiencies in the quality of health services in that country. The exercise so motivated this national team to address the issue of low quality of services that they compiled its findings and produced a well conceived, feasible (both technically and financially) and comprehensive plan of action in the space of a few months, on which they received strong national consensus. While it had initially been envisaged that a project would be developed to finance recommendations emanating from that sector work, in actual fact, the plan of action was developed and approved so rapidly and government commitment to address the issue was so high that funds from the ongoing Human Resources Development project were earmarked