By now, it has become routine to learn of one impending health scare or the other.
Even as Ebola seems to have been bested in Africa, terrifying reports of the outbreak of the Zika virus are coming in from South America. Closer home in India, the growing spectre of lifestyle diseases threatens large populations, especially in urban areas. And the just-released National Family Health Survey data reveals, among other things, that India has miles to go in ensuring health insurance coverage for its people.
However, amidst all the gloom and challenges associated with public health, there are also areas where India has been achieving commendable successes. One such area has been the fight against Neglected Tropical Diseases (NTDs).
NTDs refer to a group of bacterial and parasitic diseases that are spread by insects like mosquitoes and flies, or by contact with contaminated soil or water. A key characteristic of NTDs is that they disproportionately affect the poorest of citizens, and hinder their access to economic, educational, and social opportunities. An example of an NTD is lymphatic filariasis (LF)—or, elephantiasis (or hathipaon in Hindi) as it is commonly referred to.
It is against LF that India has been conducting a demonstrably successful campaign for a while now. The flagship part of this effort has been the National Filaria Week (NFW), during which free and safe medication that both prevents and treats LF is distributed to people living in those districts that are still identified as endemic for the disease.
In the 2015 edition of the NFW, the number of such districts was 137—a huge drop from the 255 such districts when the consolidated campaign first began a decade ago. Improvements are also evident at the state level. In my home state of Odisha, the population that has been estimated to be at risk has dropped from 26.2 million people across 20 districts in 1996 to 11.9 million people in 10 districts in 2015.
Without doubt, credit is due to the many people who are responsible for this success: Civil servants in the union ministry of health and family welfare, the state filaria programme managers and teams, and the ASHA workers who undertook the door-to-door distribution of medication. That strong leadership at the highest levels, combined with coordinated action at the grassroots, can achieve this advancement in public health is an inspiring signal at a time when many concerns about the future of healthcare in India abound.
Of course, recognising this remarkable progress should not detract from redoubling efforts to achieve the complete elimination of this disease. After all, the last mile is usually the hardest. To grasp the ever-so-close goal of total eradication of LF from India, there are three things that should be kept in mind.
First, sustained progress toward LF elimination depends not just on achieving health-related goals, but is also linked to environmental and sanitation goals. For example, LF is transmitted by mosquitoes that breed in stagnant water. Thus, water, sanitation, and hygiene initiatives like the Swachh Bharat (Clean India) campaign should also form an integral part of the discussion on tackling NTDs in a sustainable manner.
Secondly, as India nears the curbing of transmission of new LF infections, the focus must turn to providing support and rehabilitation for those living with advanced stages of the disease. LF can lead to lifelong disability that limits a patient’s ability to engage in a productive livelihood. Given that the disease mostly affects the poorest of the poor, the disfigurement associated with advanced stages of LF keeps patients and their families locked in a cycle of poverty, and discrimination. Thus, a crucial component of India’s victory over LF would be adopting and implementing a robust morbidity management plan to support those who are already suffering from the disease.
The National Vector Borne Disease Control Programme has already started taking steps to address the issue of the ongoing pain and disability resulting from the disease. However, constant vigilance is required to guard against the possibility that, in the jubilation over halting infections, those who are already infected are forgotten.
Thirdly, the mass administration of the filaria drug is important not just because it controls LF, but also because it helps fight soil-transmitted helminths (i.e. intestinal worms). This is a critical intervention to secure a healthy generation of children. It must be ensured that similar programmes continue even after India’s anti-filaria programmes achieve success and are ceased.