A healthcare safety net for all

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A healthcare safety net for all

Monday, 17 December 2018 | NS Dharmshaktu

The new drug regimen for filariasis in India will be a key step in achieving ‘health for all.’ But more than the drug, people need to be educated about the spread, treatment and ways to mitigate the disease. Awareness calls for collective efforts

Countries across the world celebrated December 12 as the Universal Health Coverage (UHC) day to mark the journey towards achieving ‘health for all.’ Over 40 years have passed since the target of universal health was set by the World Health Organisation (WHO) Assembly in 1977 to ensure affordable healthcare across the globe. This is an opportune moment to take stock of how we have fared so far.

There is no denying the fact that ‘health for all’, which is a part of the Sustainable Development Goals (SDGs), can only be achieved through effective community engagement and universalisation of healthcare services. India, too, has been steadily working towards this goal, and like many other nations, our journey towards universal health coverage is defined by the reach of our healthcare delivery system to the last mile of the population.

Since population coverage is fundamental to this journey, investing in health programmes that deliver treatment to families at their doorstep irrespective of their socio-economic status will play a key role in realising the ‘health for all’ dream. One such scheme is the Mass Drug Administration (MDA), which will soon be strengthened with the introduction of new triple-drug therapy that will help the elimination of lymphatic filariasis.

A disease that affects the marginalised sections of society, filariasis is a mosquito-borne infectious disease that has become one of the major public health challenges for the country today. A known cause of permanent disability, it damages the lymphatic system, and if left untreated, it incapacitates individuals during the peak of their productive years. Reports from the National Vector-Borne Disease Control Programme indicate that around 8.77 lakh cases of lymphedema (swollen limbs) and 3.87 lakh cases of hydrocele (swollen scrotal sac) were caused due to filariasis in 256 endemic districts across India. It also estimated that around 20 million children and adolescents suffer from Acute Adenolymphangitis that on an average lasts for about four to seven days in each episode. People with lymphedema need disability impairment services and they must be covered under the Rights of Persons with Disabilities Act, 2016.

The Government of India launched the MDA programme in 2004 with a combination of two drugs — diethylcarbamazine citrate (DEC) and albendazole. While administration of the drug is free of cost, preventive treatment has helped the programme reduce infection levels in 107 out of 256 districts.  A major challenge is low compliance to the treatment by communities.

A large section of society still does not know about filariasis and the importance of consuming MDA medicines annually. When more than 65 per cent of the population fails to comply with MDA treatment, it creates a potential reservoir of infection for parasites to feed on, thus reducing the probability of the programme’s success. As a result, even today, about 377 million people in India remain at the risk of contracting filariasis. The need of the hour, therefore, is to educate people about how filaria spreads, its consequences, vector-control measures and promote a sense of ownership of elimination efforts in the community.

Tanzania and Togo are successful examples of developing countries that combined community engagement and effective use of MDA treatment to eliminate filariasis. Recently, Kenya, Samoa and American Samoa rolled out the new Triple Drug Treatment (IDA). India will be the first country in South East Asia to introduce the programme. The third new drug, Ivermectin, will prove to be a game-changer for the elimination of filariasis. It paralyses not just the microfilariae but also the adult worm, making IDA a faster means to break filariasis transmission. The WHO has been playing an important role in establishing link with external partners. It is also helping in expanding the supply of medicines and building capacity in endemic countries.

Apart from this, innovative strategies that include a vector-control component in smart cities missions, mandatory web-based reporting of vector-borne disease cases, ensuring proper sanitation and sewage facilities, clean water supply and regulated construction sites, can help control spread of vector-borne diseases like filariasis.

Fostering collaborations with all relevant stakeholders — between local civil society organisations and departments, especially at district, block and village levels — can contribute to better eliminate lymphatic filariasis. Local health committees and governance structures can be effective mechanisms to ensure community participation — people are more likely to use and respond positively to health services when they are involved in decisions related to delivery of public health services.

Progressive strategies like these and policies such as the Ayushman Bharat National Health Protection scheme, which aims to holistically address health at the primary, secondary and tertiary level, can have far-reaching impact in eliminating vector-borne diseases. These efforts, however, should not just be a one-point destination but a long-term investment and commitment towards shaping communities as agents of change. It is the responsibility of each one of us to encourage better health-seeking behaviour and build an inclusive and sustainable pathway to forge a truly strong and healthy India.

(The writer is Principal Advisor, Ministry of Health & Family Welfare on public health. The views expressed are personal)

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