Every second death in India occurs due to one or the other non-communicable disease and one in fourth is due to cardio-vascular disease. An estimated 45 million Indians suffer from coronary artery disease (CAD). At the current rate, India will have the highest number of cardio-vascular diseases (CVD) in the world.
India’s is considered to be the diabetic capital of the world – 50.8 million Indians are estimated to be suffering from diabetics. Overall, 78.6 per cent of the Indian population have two or more risk factors.
Both these diseases are expected to reduce global GDP by 5% by the end of 2015, according to a report of the working group of the erstwhile Planning Commission of India. Approximately half of the total economic burden is reported to account for by CVD including stroke, ischemic heart diseases (IHD) and peripheral vascular disease, which together cause more deaths than HIV/AIDs, Malaria and Tuberculosis combined.
The working group had projected an estimated loss to the country due to premature deaths from heart disease, stroke and diabetes during the current decade of 2005-2015 at a whopping 237 billion USD.
While heart diseases and diabetes are the two major killers, there is no institutional or structured campaign to arrest its burgeoning burden. On the other hand, there are only 20.9 lakh people living with HIV/AIDs, which constitutes 0.27% of the adults according to 2011 estimates.
According to a report by UN AIDS programme, India has the third highest burden of people living with HIV in the world with 2.1 million affected, while it accounted for 51% of AIDS-related deaths in Asia in 2013 and 8 per cent of deaths worldwide.
The annual addition of persons with HIV/AIDS has been decreasing since India launched a national AIDS control programme in 1992. The adult HIV prevalence has decreased from 0.41% in 2001 to 0.27% in 2011. Also, the estimated number of people living with HIV has decreased from 24.1 lakh in 2000 to 20.9 lakhs in 2011.
In the recent times, there has been a sense that HIV/AIDS control has been attracting a higher slice of funding, including donor health funding, though the mortality rate of HIV/AIDS was much less to several other NCDs. The first National AIDS Control Programme in India was launched with an external credit of 84 million USD, the second 191 million USD and 674 million USD for the third national programme 2007-12.The fourth National Aids Control Programme has an external funding component of 255 million USD of the total project cost of 510 million USD. Several global funding agencies like World Bank, The Global Bank, USAID, The Clinton Foundation, UNDP and WHO have been lending assistance to India in its campaign against HIV/AIDS.
A study by the School of Economics, University of Queensland indicates global development assistance for health to several African countries has increased for HIV/AIDS in the past decade, figures show that the resources committed to other health concerns have seen only modest increase or even a relative decline.
Several health administrators, present at the recent Scientific Day organised by MedicinsSans Frontieres simultaneously in London and New Delhi, concurred in private with the above study. They even went to the extent of saying, HIV/AIDS eradication is influenced by global humanitarian funds supported by multi-national pharma majors in US and Europe.
Despite such huge investment to eradicate HIV/AIDS from the country, activists complain shortage of Anti-Retroviral Therapy (ART).
“We have written two letters to NACO regarding HIV-test kits stock out. But we met no response. So we went ahead and sent a letter to the Health Minister trying to make him aware that HIV-test kits are not available for the past one year,” said Paul Lhungdim, Coordinator with Delhi Network of Positive People (DNP+), a voluntary organisation working for the welfare of HIV/AIDs affected.
“It’s a shame that generic anti-retroviral drugs, all being manufactured at our doorsteps can’t me made available to people affected by HIV in the country,” said Dr. N. Kumaraswamy, Chief Medical Officer of YR Gaitonde Medical Educational and Research Foundation, Chennai and Clinical Adviser to Clinton Foundation Health Access Initiative. “The first study outside Europe and US shows, death rate in HIV infected people are coming down dramatically following antiretroviral treatment.”
No doubt, HIV/AIDS is a life-threatening and entirely preventable disease. But there are several other diseases with higher morbidity and mortality rates in India. Its prevention should also get the same if not more institutional support as in the case of HIV/AIDS and external funding should not merely be the guiding principle.
“Almost 85% of all patients of Stage 5 of chronic kidney disease do not get regular treatment and succumb to their illness in some duration of time,” said Dr. Sanjay Agarwal, Head of Nephrology Department, All India Institute of Medical Sciences, New Delhi. “The burden of Chronic Kidney Disease constitute 10% of the adult population in India.”
This sums up the management of healthcare in India. Every year about 39 million Indians are pushed to poverty due to ill-health. Worse, according to a report of the WHO, around 30 per cent of rural India do not go for any treatment due to financial constraints.
(By N.B. Nair, writer is based at New Delhi and Executive Editor of Indian Science Journal)