Despite large funds released by the Centre, India struggles to control diseases
BESIDES FDI, another issue generated heat during the winter session of Parliament: increasing number of vector-borne diseases in the country. Data presented by the Ministry of Health and Family Welfare showed that more than 0.7 million people were affected by dengue, malaria and chikungunya this year.
The data was collected by the National Vector Borne Disease Control Programme (NVBDCP), which oversees the control of six diseases—malaria, chikungunya, dengue, Japanese encephalitis, kala azar and filaria. According to NVBDCP’s website, till October-end, 18,564 cases of kala azar were reported; 23 patients died of it. By November 30, 704 cases of Japanese encephalitis were reported; 136 patients died.
Through NVBDCP, the Centre provides technical and financial support to states. NVBDCP is one of the most expensive healthcare programmes. Under the 12th Plan, the proposed budget for NVBDCP is Rs 10,693 crore, a steep rise from last Plan’s Rs 3,190 crore.
During the Parliament session, the ministry contended that only dengue cases are on the rise in the country (see table). It attributed the increase to unprecedented human population growth, unplanned urbanisation, inadequate waste management, ecological and lifestyle changes and poor infrastructure to monitor mosquito breeding. Malaria is spread by Anopheles culicifacies mosquito; dengue and chikungunya by Aedes aegypti; filaria by Culex quinquefasciatus; Japanese encephalitis by two species of Culex; while kala azar is spread by the sand fly. “It is difficult to control the density of the vector as many of them lay eggs in water accumulated in small quantities,” says A C Dhariwal, director of NVBDCP.
Where programme falls short
Despite the increased funds outlay, NVBDCP has had little effect. This year, Tamil Nadu recorded the highest number of dengue and chikungunya cases.
R T Porkai Pandian, director of the Directorate of Public Health and Preventive Medicine in Tamil Nadu, blames climatic conditions. “We took adequate preventive measures,” he says. But underutilisation of funds has been a chronic problem in the state. Of the Rs 908 lakh allocated during 2012-13, the state utilised only Rs 126 lakh under NVBDCP. The year before, the state used only Rs 341 lakh of the allocated Rs 764 lakh.
The high number of cases of vector-borne diseases suggests that control measures are in poor state, says V P Sharma, former director of the National Institute of Malaria Research. “In most places, a fiftieth of the required insecticide is provided,” he adds. Leena Menghaney, access campaign manager-India of NGO Médecins Sans Frontières, says NVBDCP has major supply chain issues. For instance, the drugs for treating kala azar and malaria were in short supply this year. “Even rapid testing kits for malaria were not available which made controlling the disease difficult despite good policies in place,” she says.
Sharma suggests that instead of running NVBDCP, the directorate of the programme should only monitor and let the states take the onus of vector control. Vector densities are dependent on local ecology and require local solutions, he says. “We have the technology to control the diseases, but this cannot be done if we do not use them.”
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