In the past month, Delhi witnessed a political storm as Dengue, Malaria and Chikungunya related deaths were reported in the country's capital, exposing the Delhi government’s inability to tackle the combined challenge. What got ignored in the blame game between political parties was the problems faced by the country’s public health system. According to official data, Delhi had about 4650 cases of Chikungunya till September 25, 2016, an increase of around 80 times from last year.
This year, Chikungunya in Delhi accounted for 25 percent of the national caseload, and is reported to have claimed over
50 lives in the city. This unprecedented attack of Chikungunya has overwhelmed the system and created wide panic, when it was followed by the seasonal Dengue epidemic. Dengue, which caused 15,867 cases and 60 deaths last year, according to official numbers, caused a comparable public outcry to last year, even if the scale was much less this year. Even Malaria is said to have come back, and there are reports of Malaria deaths in the
city for the first time in five years, based on official numbers.
This year, Chikungunya in Delhi accounted for 25 percent of the national caseload, and is reported to have claimed over 50 lives in the city.
If that wasn’t damning enough, last week, the Lancet published the results from a new index developed to assess each country’s achievement on a range of health indicators. The index ranked
India at 143 in a list of 188 countries, six places ahead of Pakistan, but way behind countries like Sri Lanka (79), China (92), even war-torn Syria (117) and Iraq (128). One of the health-related indicators in the index was Malaria, where India did particularly poorly.
It is not the best picture that we, as one of the fastest growing economies, present to the world — where people are still dying of vector borne diseases. Major vector borne diseases identified in India are Dengue, Chikungunya, Malaria, Japanese Encephalitis, Filaria and Kala Azar. Though there are several government interventions and programmes targeted to address the issue, they have often been found inadequate. The central government finances National Vector Borne Disease Control Programme under the National Health Mission. There has been a 12 percent increase in the National Health Mission budget, from ₹17,188 crore to ₹19,307 crore between 2012 and 2016 however the budget allocation for vector borne diseases came down from
₹572 crores in 2013-14 to ₹463 crores in 2015-16.
It is not the best picture that we, as one of the fastest growing economies, present to the world — where people are still dying of vector borne diseases.
India’s current health problems are primarily because of the very low fund allocation to health — one of the lowest in the world. India spends 1.4 percent of GDP on public health while China spends three percent and UK eight percent. India needs a focused action plan to address the challenges of vector-borne diseases, particularly Malaria, which remains the single largest killer amongst the vector borne diseases. While open defecation and similar determinants that contribute to the problem are being looked into and budgeted for, it is a challenge that needs to be prioritised so as to achieve a Malaria free country status. There are lessons that we can also take from Sri Lanka that was recently declared malaria-free by WHO. Of course the size of the country and its climatic condition do differ but their resolve to eradicate Malaria is worth emulating.
Sri Lanka achieved its goals in eradicating malaria through a sustained campaign over a period of seven decades which included a civil war. They managed this through a focused
three dimensions strategy:
- An effective vector control programme,
- A three pronged parasite surveillance programme, and,
- Treatment of the disease.
At the same time, Sri Lanka also made reporting malaria cases a legal requirement. The country’s public health system, with its extensive network of primary medical centres and health workers ensured that not a single person was left out in their focus to rid the country of the scourge. Their anti-Malaria campaign was funded by the government, supplemeted by contributions from international agencies. Educating people, mobilising opinion, effectively using insecticides, providing insecticide-treated mosquito nets and conducting door to door campaigns were some of the measures taken by the health department.
India of course has its own success stories. India was declared Polio free in 2014, a huge public health achievement. The journey towards eradication began a little over two decades ago in 1995, when the disease used to cripple
more than 50,000 children in the country every year. This achievement became possible through technological innovations like the indigenous Bivalent Polio Vaccine, adequate domestic financial resources and close monitoring of the Polio programme. A 2.3 million strong team of Polio volunteers and 150,000 supervisors worked day and night to reach every child.
A similar and sustained approach could also help realise India’s dream of making the nation free of such diseases. It has all to do with priority and focus.
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