Swine Flu cases remain unabated in India, throws up challenges to public health emergencies.
New Delhi – Way back in April 2009, India’s federal health ministry issued a communique, announcing a series of preventive measures to deal with the emerging public health emergency due to Swine Influenza A or Swine Flu as is commonly known (H1N1) after the outbreak of the disease in United States and Mexico. Travellers coming to India were screened, stepped up surveillance and issued travel advisory for those travelling to the affected areas. The first death in the country was reported from Pune, in the western part of the country. By May 2010, 1035 people lost their lives to the disease from 10,193 confirmed cases.
Even as India’s federal Health Minister J.P. Nadda assured the country’s lawmakers, there was no need for panic as medicines and facilities to tackle the disease were in place, in government’s own admission, there has been considerable rise in the number of swine flu cases and deaths in the country over the years. According to the National Health Profile 2013 – the latest in the series available, there has been 72.6% increase in the number of deaths by the disease in 2013 over 2012. Though the death toll recorded a marked decrease in 2014 – only 218 cases from a total of 937 cases, but it went up exponentially by 320 per cent in the first two months of 2015. Between January 01 to February 22, 2015, according to the statement by the minister, 841 people lost their lives to the epidemic, from 14,673 confirmed cases. But the minister claimed, many of the deaths could be due to ‘co-morbidities in the patients’.
India has been able to eliminate or arrest the spread of several communicable diseases that hit the country in the past, like Polio, Filaria and Malaria, but newer vector-borne diseases have added to the burden of health providers and planners. This includes Dengue, Chikungunia besides Swine Flu.
It took 19 years for the country to eradicate Polio, a disease that crippled more than 50,000 children every year, completely. Surveillance was the game-changer in the fight against polio. It also marked a strategic shift in India’s polio eradication efforts.
“The setting up of a surveillance system proved to be the most important milestone in the journey of polio eradication in India, as it formed the backbone of the eradication drive by helping identify areas and populations that were at risk and the type of poliovirus circulating in different areas besides measuring progress,” remarked a WHO official in India.
But a similar multi-pronged campaign involving a number of national and international agencies on a sustained basis has not been witnessed in the case of other communicable diseases. India reports about two million confirmed cases of Malaria and recorded an average annual death toll of 743 during the past six years, but according to WHO, there are about 15 million cases and 20,000 deaths. India contributes 77% of the total malaria in Southeast Asia.
At the dawn of India’s independence in 1947, 75 million malaria cases in a population of 330 million were estimated. In the late 1950s and early 1960s, spectacular achievement was witnessed in eradicating the diseases and malaria cases significantly declined to just 100,000 in 1964. However, reversal was experienced, and malaria staged a comeback. By 1976, malaria cases had touched the 6.4 million mark. It still continues, despite huge budgetary allocation and loss of human lives.
Kala Azar is the second largest parasitic killer in the world – second to Malaria, but one of the most neglected tropical diseases. Its prevalence is mainly confined to three states in India – Bihar, Jharkhand and West Bengal, though some cases were also reported from Assam, Sikkim, Uttarakhand, Uttar Pradesh and Delhi. The annual incidence of Kala Azar cases is about 25,000 cases with a mortality figure of 65.
Dengue and Chikungunia are two newer varieties of vector-borne diseases, with an average annual incidence of 42,000 cases of Dengue and 161 deaths during the last five years. There was no mortality from Chikungunia.
Health experts are concerned about the recurrence of communicable diseases in India, the latest being Swine Flu. They however, squarely blame lax public involvement in community hygiene, which triggers and sustains communicable diseases.
“Generally people are very concerned about their personal hygiene. When it comes to community level, they are totally different,” said Dr. K.N. Panicker, Emeritus Professor and Advisor to WHO, adding community participation and citizen engagement in hygiene and preventive healthcare as key factors to a disease-free society.
Healthcare in India lags behind those of peer nations. The situation is further accentuated by inequity in healthcare access across states and demographic segments within the population. The federal government has articulated its intention to achieve ‘universal health coverage,’ by the end of 12th Five Year Plan, i.e., 2017. It mandated an increase in public expenditure on health to at least 2.5 per cent of the GDP and increase it to at least 3% by 2022.
A 2012 study by Indian business lobby FICCI and consultants EY estimated that universal health cover in India was feasible in a decade and would require government health spending to rise to 3.7-4.5 percent of GDP
Currently, Indian healthcare sector faces huge shortage of workforce and infrastructure. The bed density in the country is 0.51 per 1,000 population, according to National Health Profile 2013 – far below the global average of 2.6 and WHO benchmark of 3.5. The doctor-population ratio was also below WHO prescribed guidelines of 2.5 doctors for a population of 1,000 – India’s doctor-population ratio in 2013 was 0.74 doctors for 1,000.
India’sannual health burden is about 19.22 billion US dollars, which works out to about 7.39% of the annual budget of the government of India. However, only 22.38% of this is spent by the government, while the rest flows from private funds.
However, health-related indicators available at present are based on data mostly relating to state-run facilities; there is no credible data available with any agency – government or private in India on healthcare. Even the latest National Health Profile 2013 for instance, refers to period varying from 2003 to 2013. It does not include the data from almost a two-third of the health providers, in the private sector. This makes planning in the health sector unrealistic and far from ground realities.
As the country embarks on an ambitious plan to achieve the goal of universal healthcare, the immediate priority should be strengthening of healthcare infrastructure, especially in rural India, which faces the twin challenge of lack of health facilities and poverty and ignorance.