Menace of Dengue & Chikungunya: What India needs to do?
UPSC GENERAL STUDIES PAPER II: ISSUES RELATED TO HEALTH
Table of Content:
India’s
Goal vis a vis Vector Borne Diseases
Numbers
tell the story
- Health
Expenditure to GDP ratio
- State’s
Share of Health Expenditure
- OOP Expenditure
Causes
of rampant spread of infections such as dengue, chikungunya, H1N1, malaria, TB
Consequences
of falling ill
- Medical
Consequences
- Social
Consequences
- Economic
Consequences
- Global
Consequences
Measures
taken at Present
- Fumigation
- Door-to-Door
Inspection
Measures
that must be taken
- Individual
Level
- Local
Government Level
- State/National
Level
Conclusion
Associated
Development
Bibliography
India’s Goal vis a vis Vector Borne Diseases:
Eliminating malaria by 2030, and curb other
vector-borne diseases, there has to be sustained effort and political will. Let
us see where we stand today…
Numbers tell the story:
Health Expenditure to GDP ratio
·
9.94%:
Total Healthcare Expenditure as a
proportion of GDP (World as a whole)
·
4.7%:
Total Healthcare Expenditure as a
proportion of GDP (India)
HALF!!
State’s Share of Health Expenditure
·
61%: Average for State’s Share (World as a Whole)
·
30%:
Indian State’s share of healthcare
expenditure in India
HALF!!
Proportion of healthcare expenditure borne out
of pocket as opposed to some pooling mechanism (insurance or public healthcare)
·
18.2%: World average
·
62.4%:
India
GREATER THAN 3X!!
The above stats
translate into an oft-repeated stat: Indian government spends 1.4% of GDP on
health.
Reason why India’s Health Infrastructure is in news recently:
15.09.16: Deadly
outbreak of dengue and chikungunya in Delhi
Delhi has also been
struck by a mystery fever, symptomatically like dengue and chikungunya, but
testing negative for these mosquito-borne diseases.
Causes of rampant spread of infections such as dengue, chikungunya, H1N1, malaria, TB:
·
Inadequacy
of prevention measures
·
Inadequacy
of primary health centers in dealing with local
level outbreak of diseases.
· Increasing
travel and migration between states has led to
diseases that were endemic to some states causing outbreaks across India. In
2010, West Bengal had close to half of India’s more than 48,000 chikungunya
infections, and in 2015, an outbreak in Karnataka accounted for more than two
thirds of India’s more than 27,000 infections. This year, the mosquito-borne infection crossed several state boundaries to
affect several hundred people in Delhi, where only six cases — all in
travellers from affected states — were reported in 2012.
Consequences of falling ill:
Medical Consequences: The chronic outbreak of diseases and improper cure, is causing many of
the diseases to become increasingly drug resistant –
therefore more difficult to cure and thus more debilitating.
Social Consequences:
Increased vulnerability of family/group of
families: With disease
come attached disabilities such as helplessness, desperation which puts
pressure on social standing of the ill.
Economic Consequences:
Chronic Poverty: One health emergency is all it takes to push
a family that has pulled itself out of poverty back into the abyss.
Loss of Productivity: A chikungunya patient takes days, even weeks,
to recover. Dengue is similarly debilitating. There have been reports of an exodus of workers from Delhi. This has brought
construction work at many sites to a grinding halt.
Limits India’s future prospects: India cannot become a knowledge economy or a global power with its current quality of
healthcare.
Global Consequences:
Loss of repute: Tags such as disease
capital etc. are attached to Indian cities; naturally this becomes an
impediment in the flow of human talent.
Unflattering comparisons: The irony is that India, with its focus on
rapid economic growth and prosperity, is nowhere near victory in the battle
against productivity-sapping infections spread by mosquitoes and other insects,
while a nimble neighbour like Sri Lanka could declare
itself malaria-free.
Measures taken at Present
Fumigation: Fumigation, the standard practice for dengue
prevention, is harmful for asthma patients and pregnant
women and does not stop mosquito breeding. It only kills the adult
mosquito. Worse, the municipal officials say they know that fogging is ineffective but still continue with it on
popular demand.
Door-to-Door Inspection: Most residents resist
inspection and complain of harassment when they are fined Rs. 500. It
seems to suit everybody that fewer households have been checked for mosquito
breeding this year.
Measures that must be taken:
Individual Level: Must focus on personal and community level
hygiene and healthy living habits.
Increase Civic Consciousness: India contributes 60 per cent of the world’s
open defecation with just 17 per cent of its people. Civic consciousness on above
such other issues as not allowing mosquitoes to breed is a must.
- It is cheaper to kill mosquitoes at the larvae stage. Aedes does not breed in dirty drains. It needs clear water. Due to stagnant water in desert coolers, overhead tanks, Feng Shui plants and water collecting from condensers of ACs and refrigerators, half of those infected are bitten in their own homes.
- Encourage door-to-door inspection
- Resident Welfare Associations/Rotary Clubs and such local citizen bodies must become active on these fronts
Local Government Level: Must focus on preventive public health measures
Effective use of existing funds and further
deployment if necessary
- Fill up vacancies
- Ensure accountability
- Hire more if necessary
Providing Clean Drinking Water
Timely and Efficient Disposal of Sewage and
Solid Waste
Hold Primary Health Centers Accountable: Not just the public one for providing
service, but also the private ones for not duping by admitting anyone with just
a high fever!
State/National Level
Ensure robust data
collection mechanism at the ground level: Important not just to assess
the magnitude of the problem but also for deployment
of adequate resources.
- A 2014 study by researchers from Brandeis University, USA, Centre for Research in Medical Entomology, Madurai, Delhi-based National Institute of Health and Family Welfare (NIHFW) and the INCLEN Trust International concluded that the burden of dengue in India was the heaviest in the world. For every single officially reported dengue case at the national level, 282 went unreported in official records.
- Donald Shepard who led the 2014 study told The Economist that India must start publishing official data of both confirmed and suspected cases of dengue, a practice followed in many countries including the US.
(Note: Citizens can be involved;
e-governance and ICT can be deployed; ASHA like personnel deployed to do a
census)
Increase the expenditure on preventive and
curative healthcare at the Primary Level: Since there is no vaccine for dengue, only early detection and good
medical care can lower the damage and fatalities. World
Bank estimates say that one dollar used in preventive measures saves nine in
treatment.
Prepaid, pooled expenditure must be the norm in
health spending: This does
not mean blindly spreading health insurance. Healthcare outfits that take
charge of the well-being of an assigned set of people and use a network of
general practitioners and secondary and tertiary hospitals in return for a
premium per person works better than hospitals and insurance that have
misaligned incentives on costs.
Raise the number of Healthcare Professionals at
the primary level: It is
the super-specialist doctor who lays claim to fame, but it is the primary healthcare professional who saves lives in hundreds
and thousands.
Learn from Sri Lankan Experience
- Integration of different approaches.
- Focusing on mosquito control in irrigation and agriculture
- Introducing new classes of insecticides for residual spraying within houses
- Scaling up distribution of insecticide-treated bed nets
- Mobile centres for access to diagnostics and treatment to halt disease transmission.
Conclusion
Quality
care is a must and if policy-makers have the will, India has the skill and
resources to provide it. India attracts medical tourism for its high-quality,
low-cost advanced care, and has emerged as the global pharmacy for inexpensive
drugs and vaccines. Yet India’s low public outlay so far makes it impossible
for the public sector to respond to the growing health needs of the population.
What is needed now is transformational initiatives in health financing,
public–private mix in service delivery, and strengthening primary care to take
health to people’s doorsteps to lower inequities.
Associated Developments:
- The health ministry has rejected the French drug and vaccine company Sanofi’s request to waive additional clinical studies required to introduce the dengue vaccine, Dengvaxia, in the country. (THIS CAN CONSTITUTE AN ETHICAL DILEMMA - PAPER IV ETHICS)
- In 2013, the International Centre for Genetic Engineering and Biology (ICGEB) in Delhi reported success in its attempt to develop a dengue vaccine. The endeavour was lauded in the international press but of late, scientists have been complaining that a fund crunch has stymied their efforts to fast-track the project.
Bibliography
- 13.09.16: Upgrade health centres to fight
new challenges
- 14.09.16: To stop future outbreak of
diseases, equip the public health sector
- 15.09.16: Sapping India's Vitality
- 15.09.16: Cease and Disease
- 15.09.16: To fight dengue, we must come
out of denial
- 15.09.16: Disease in capital underlying
India's poor health
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