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Human indices: Lanka, B’desh deserve applause

In early September Delhi reported its first cerebral malaria death in five years, and coincidentally at the same time, the WHO (World Health Organisation) declared Sri Lanka to be malaria free.

Human indices: Lanka, B’desh deserve applause

MORE SMOKE, LESS FIRE: A worker fumigates an area to prevent mosquitoes from breeding in New Delhi. AFP



C Uday Bhaskar

In early September Delhi reported its first cerebral malaria death in five years, and coincidentally at the same time, the WHO (World Health Organisation) declared Sri Lanka to be malaria free.

Over the past month different parts of post-monsoon India have been grappling with various kinds of epidemic scares. Raging fevers have seen anxious patients rushing to path labs for blood tests to identify the kind of debilitating fever that has spread in clusters and ailments like typhoid, malaria, dengue and ‘murgiwala-bukhar’ (chikungunya) have become part of the local lexicon.

Malaria, a mosquito-borne disease, is a challenge to the developing world. The UN estimates that almost half the world’s population – over 3.2 billion are at risk. Africa and southern Asia are particularly vulnerable given the poor socio-economic indicators and public health investment, and India is one of the more malaria prone nations.

A WHO factsheet notes that in 2015, there were roughly 214 million malaria cases globally, and an estimated 4,38,000 malaria deaths. However the good news is that increased prevention and control measures have led to a 60 per cent reduction in malaria mortality rates since 2000.

While sub-Saharan Africa continues to report the highest incidence (the region was home to 89 per cent of malaria cases and 91 per cent of malaria deaths), India has a huge challenge ahead of it.

In many parts of the developing world the three killer diseases are diarrhoea, typhoid and malaria, in that order. As per government sources, malaria is showing a rise. From 8.81 lakh cases reported in 2013, the figure moved up to 10.7 lakh in 2014. Rural India, where sanitation is poor and mosquito protection far from adequate, has the larger footprint, though the Delhi fatalities (September 4) should have the amber lights flashing.

The mortality figures for malaria-related deaths in India have been contested for some time and this is yet another strand of the challenge. Many parts of rural India are not covered by state-led health programmes and it is averred that many cases of death are not accurately reported.

An international survey (2010) estimated malaria deaths in India to be 2 lakh annually, while the government had a much lower figure of below 10,000. Even if the lower figure is accepted, it is a poor reflection on the current state of human security indicators in India.

Before reviewing the Sri Lankan success story, it may be pertinent to highlight another commendable achievement in the South Asian region. In March this year Bangladesh proudly declared that it had achieved a 99 per cent open-defecation free benchmark and the last 1 per cent remains the final challenge for the Hasina government.

This is a remarkable public health and civic achievement and from a 42 per cent figure in 2003, the Bangladesh government and local communities have brought the figure down to one per cent. Being compelled to defecate in the open must rank as one of the most degrading personal experiences and that millions of Indians still have to go through this ignominy is yet another human security-cum-dignity indicator that must be redressed with urgency.

A UNICEF report estimates that as many as 595 million Indians (half the population) do not use a regular toilet with appropriate privacy. Within SAARC, Nepal and Pakistan also have a similar challenge – albeit of a lower percentage. It is creditable that Sri Lanka and now Bangladesh have already attained the goal of zero open defecation.

In a remarkably candid admission, Prime Minister Narendra Modi in his first Independence Day speech from the ramparts of the Red Fort in August 2014 agonised over the reality of open defecation and exhorted the country to work towards a clean India that would include ‘toilets for all’.

The 150th birth anniversary of Mahatma Gandhi in October 2019 was identified as the target date by the Prime Minister to achieve this objective and this is a challenge that must remain on the radar of the national collective. Episodic attention and abdication of civic responsibility is a tenacious national trait and both the objectives of being malaria free and the elimination of open defecation must not be allowed to go down this path of amnesia and indifference.

Here both Sri Lanka and Bangladesh have much to share with the entire developing world. India in particular must find the humility and earnestness of purpose to learn from its smaller neighbours. Some streams of the national discourse often dwell on a rising India and a potential great-power — but this aspiration often ignores the reality of a country that ranks low on most human security indicators as identified in the UN Millennium Development Goals.

There is a strong case for India to aspire to be an equitable and empathetic nation that prioritises comprehensive human security in the first instance, even as it grapples with the more complex challenges of traditional national security that range from nuclear weapons to the more recent Pathankot kind of terrorist attacks.

Whether malaria eradication or the provision of appropriate toilets for their citizens, both Colombo and Dhaka have demonstrated that despite a modest national resource kitty, concerted political determination, institutional integrity and an alert and involved civil society can work in tandem and attain the desired results.

But the starting point for India is to get out of the comfortable complacency cocoon and face some less than palatable realities. It is moot to ask if a malaria death in the national capital has elicited more than a yawn and has the political constituency relegated this public-health indicator to the back burner? As the electoral cycle begins in different states, civil society in India must demand more accountability and action from their elected representatives.

Can Chandigarh lead the way? A malaria-free and zero open defecation region before October 2, 2019?

The writer is Director of Society for Policy Study.

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