Recalcitrant regime

a silent shift has been taking place in India's malaria profile. The malarial parasite Plasmodium vivax is no more the dominant cause of the disease. Plasmodium falciparum is taking over. This is common knowledge. Even the government knows. But what is not that clued into the public domain is the fact that vivax is relatively easier to treat and is less virulent -- meaning if you get vivax you are unlikely to cop it.

Falciparum is usually fatal. Especially when treatment regimes don't factor in the resistance falciparum acquires seamlessly. Unfortunately, the government does not react to the environment the way the parasite does. Falciparum reacts fast to new drugs. The only resistance the government develops is to new drug regimes. Being funded by the World Bank does not help, because the bank just follows the logic of the government. Moreover, because the bank follows the line of least resistance, new drugs get sidelined. The Indian government's focus is on vivax, so the bank is quite willing to go along with its priorities. Actually, the government does have an excuse. Not all falciparum in India is resistant to choloroquine and older drugs that have been used traditionally against the parasite. But drug resistance is a growing problem. So what is the extent of drug resistance in falciparum? The government hasn't bothered to find out enough to say for sure.

RELATED STORY • Malaria : The failure of the public health care system [June 15, 2006]

The problem of resistance is complicated. The question is do you go for a blanket combination regimes or risk people dying. Certainly, people who die because of inadequate medication are not being dealt with by the government health machinery. This is happening because of poor reportage. Most of the time, state governments and the Centre don't collect enough data on the disease to know the enormity of the problem. Even when a database is put together, proper use is not made of it. The problem is coordination. States often do not provide information to the Centre. Which means that programmes in which both are involved don't take off because various agencies work at cross-purposes and the buck keeps getting passed.

At the end of the day, the problem is about taking responsibility for providing basic services -- of which health care is a fundamental element. It's not just about malaria in Assam -- there's Japanese encephalitis in Uttar Pradesh, arsenic poisoning in West Bengal and dengue in Delhi. Until the state stands up an be counted, these won't go away.

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