Recently, El Salvador and China were declared malaria-free by the WHO.

What is Malaria?

• Malaria is a disease caused by a parasite called plasmodium vivax, p. filarium.
• The parasite is spread to humans through the bites of infected mosquitoes.
• People who have malaria usually feel very sick with a high fever and shaking chills.
• While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.

How many countries have successfully eliminated malaria?

• Since 1900, 127 countries have registered malaria elimination. This is definitely not an easy task.
• It needs proper planning and a strategic action plan based on the local situations.
• All these countries followed the existing tools and strategies to achieve the malaria elimination goal.
• The main focus was on surveillance.

How did China eliminate malaria?

• China followed some specific strategies, namely strong surveillance following the ‘1-3-7’system: malaria diagnosis within 1 day, 3 days for case investigation and by day 7 for public health responses.
• Molecular Malaria Surveillance for drug resistance and genome-based approaches to distinguish between indigenous and imported cases was conducted.
• All borders to the neighboring countries were thoroughly screened to prevent the entry of unwanted malaria into the country.

What is the current scenario of malaria in India?

• As per the Global Malaria Report 2020 by the World Health Organization (WHO) India shared 2% of the total global malaria cases in 2019.
• India has a great history of malaria control.
• The highest incidence of malaria occurred in the 1950s, with an estimated 75 million cases with 0.8 million deaths per year.
• The launch of National Malaria Control Programme in 1953 and the National Malaria Eradication Programme in 1958 made it possible to bring down malaria cases to 100,000 with no reported deaths by 1961.
• This is a great achievement been made so far.

Unexpected resurgence

• But from a nearing stage of elimination, malaria resurged to approximately 6.4 million cases in 1976.
• Since then, confirmed cases have decreased to 1.6 million cases, approximately 1100 deaths in 2009 to less than 0.4 million cases and below 80 deaths in 2019.
• India accounted for 88% of malaria cases and 86% of all malaria deaths in the WHO South-East Asia Region in 2019.
• It is the only country outside Africa among the world’s 11 `high burden to high impact’ countries.

Road ahead for India

Collaboration:

• India is a signatory to National Framework for Malaria Elimination (NFME) 2016-2030 aiming for malaria elimination by 2030.
• This framework has been outlined with a vision to eliminate the disease from the country which would contribute to improved health with quality of life and poverty alleviation.
• China collaborated with Harvard University and the Massachusetts Institute of Technology, USA for Molecular Malaria Surveillance.
• In India, there are very dedicated expert scientists who can take up such assignments.

Diagnosis:

• India stands at a very crucial stage. The present challenge is the detection of asymptomatic cases in most endemic areas.
• Molecular Malaria Surveillance must be used to find out the drug-resistant variants and genetic-relatedness studies to find out the imported or indigenous cases.
• The surveillance must be strengthened and using smart digital surveillance devices would be an important step. Real-time and organic surveillance is needed even in remote areas.

Monitoring:

• The results of each malaria case can be registered in a central dashboard at the National Vector Borne Disease Control Programme, as it is done for COVID-19 cases by Indian Council of Medical Research.
• All intervention activities must strictly be monitored.
• Vector biology, site of an actual vector mosquito bite, host shifting behaviour, feeding time, feeding behaviour and insecticide resistance studies need to be carried out to support the elimination efforts.

Get an IAS/IPS ranker as your 1: 1 personal mentor for UPSC 2024

Attend Now

Context

As India enters the second week of a national lockdown imposed in response to COVID-19, it is still unclear how well prepared the healthcare system is in dealing with the pandemic.

Need for roping in the private healthcare

• No indication of an increase in expenditure on health: A preparedness plan has to address all levels of care in terms of infrastructure, equipment, testing facilities and human resources in both the public and private sectors.
• However, so far, the Central and State governments have given little indication of bringing an increase in public expenditure on health.
• So, an already overburdened public health system will be unable to meet the increase in moderate and severe cases of COVID-19 that would require hospitalisation.
• Need for the comprehensive national policy: While some individual private sector companies have come forward with offers of creating capacity and making it available to COVID-19 patients, there is a need for a comprehensive national policy to ensure that private healthcare capacity is made available to the public.
• Some states like Chhattisgarh, Rajasthan, Madhya Pradesh and Andhra Pradesh have already roped in the private sector to provide free treatment.

What the government should do?       

• Provide universal health service: The governments at the Centre and in States have to take responsibility for providing universal health services free of charge and accessible to all.
• Tap into private sector capacity: This will require governments to not just expand the capacity within the public sector, but also to tap into the available capacity in the private sector.
• Faced with a serious health emergency, the silence of the government on the expected role of the private sector is intriguing.
• Include COVID-19 testing in PM-JAY: The National Health Authority has recommended that the testing and treatment of COVID-19 be included in the PM-Jan Arogya Yojana (PM-JAY) but this proposal is still awaiting clearance.
• Form the central command: The governance of the health service system is clearly fragmented and has created anxiety among the public.
• There is a lack of a visible central command, which should be created under the supervision of the Union Health Minister, aided by a team of experts.
• They should be tasked to make policies as and when required and communicate them to State governments, taking into account an evolving situation.
• Ensure that there is no cost to the patient: There have been some tentative measures taken by States to allow individuals seeking testing for COVID-19 to access private laboratories at subsidised rates.
• At present, the government has put a cap on the cost at ₹4,500 per test, which is a burden for even a middle-class patient.
• The poor will clearly have no access to this and the government itself does not have adequate facilities to meet the increasing demand. It is here that the government needs to ensure that there is no cost to the patient.
• Create adequate testing facilities: At this point, and certainly, before the lockdown is lifted, it is absolutely essential that adequate testing and quarantine facilities are created.
• The Central government has already taken over some private hotels to accommodate persons quarantined for COVID-19.
• One way of expanding such facilities would be for the government to ‘take over’ private corporate laboratories and hospitals for a limited period.
• Standard treatment protocol: The political directive for such a move needs to come from the Central government while ensuring that the Ministry of Health provides standard treatment protocols for health personnel.

Learning lessons from Spanish and British experience

• The Spanish government issued an order bringing hospitals in the large private corporate sector under public control for a limited period.
• This tough decision was taken with the understanding that existing public healthcare facilities would not be able to cope with the sudden, if short-term, rise in COVID-19 cases.
• British trade unions have demanded that the government make the 8,000 beds in 570 private hospitals in the country available.
• They have argued that while beds in private hospitals are lying empty, there is a severe shortage of beds in public hospitals.
• The unions have also been critical of the U.K. government decision to rent these beds at an exorbitant cost to the exchequer.

Way forward

• Rope in the private healthcare sector: In India, private corporate hospitals have, in the past, received government subsidies in various forms and it is now time to seek repayment from them.
• They are also well poised to provide specialised care and have the expertise and infrastructure to do so.
• Bring in the universal public healthcare: Universal public healthcare is essential not only to curb outbreaks but also to ensure crisis preparedness and the realisation of the promise of the right to health.

Get an IAS/IPS ranker as your 1: 1 personal mentor for UPSC 2024

Attend Now