Issues relating to development and management of Social Sector/Services relating to Health
Development processes and the development industry the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders
National Strategic Plan for Malaria Elimination
The government has recently released a national strategic plan for the elimination of malaria, and pledged to eradicate the vector-borne disease by 2027.
How bad the situation is when it comes to vector- borne diseases?
In New Delhi, which was the epicentre of a chikungunya outbreak last year and a dengue outbreak the year before, at least 50 new cases of malaria have been reported in the past week alone, taking the total number of cases since January to 225, according to the city’s municipal corporations.
Across the country, in Kerala, there have been more than 10,300 new dengue infections and the disease has claimed 21 lives this year.
Tamil Nadu has reported 4,400 cases, followed by Karnataka with more than 2,100 cases.
Swine flu is also on the rise: More than 600 people have already died and another 12,460 people have been infected this year. In comparison, there were only 1,786 infections and 265 swine flu deaths all of last year.
Similarly, chikungunya, which reappeared in this country a little more than a decade ago, has shown no signs of abating. In just three years between 2014 and 2016, there has been a 300-400% increase in the incidence of chikungunya, according to data analysed by the Centre for Science and Environment (CSE).
India has the third highest malaria burden in the world.
National Strategic Plan (NSP) for Malaria Elimination (2017-22):
The NSP is a year-wise roadmap for malaria elimination across the country based on last year’s National Framework for Malaria Elimination.
The NSP divides the country into four categories, from 0 to 3.
Zero category: It has 75 districts that have not reported any case of malaria for the last three years.
Category 1: has 448 districts, in which the annual parasite incidence (API, or the number of positive slides for the parasite in a year) is less than one per 1,000 population.
Category 2: has 48 districts, the API is one and above, but less than two per 1,000 population.
Category 3: has 107 districts, reporting an API of two and above per 1,000 population.
The plan is to eliminate malaria (zero indigenous cases) by 2022 in all Category 1 and 2 districts. The remaining districts are to be brought under a pre-elimination and elimination programme.
The NSP also aims to maintain a malaria-free status for areas where transmission has been interrupted. It seeks to achieve universal case detection and treatment services in endemic districts to ensure 100% diagnosis of all suspected cases, and full treatment of all confirmed cases.
Components of the plan:
The plan has four components, based on WHO recommendations: diagnosis and case management; surveillance and epidemic response; prevention — integrated vector management; ‘cross-cutting’ interventions, which include advocacy, communication, research and development, and other initiatives.
Salient features of the NSP :
Containment of breeding.
Strengthening malaria surveillance
Establishing a mechanism for early detection and prevention of outbreaks of malaria.
Promoting the prevention of malaria by the use of Long Lasting Impregnated Nets (LLINs).
Effective indoor residual spray.
Augmenting the manpower and capacities for effective implementation for the next five years.
Achieving the lofty goal will depend on effective implementation and sustained commitment to the project.
The government will also need to tackle the root causes of the problem, such as genetic changes in pathogens, insecticide and drug resistance, the challenges of poor urban planning.
Another area of concern is funding. Last year, the Central government released only 68% of budgeted funds under the national vector-borne disease control programme, and an even smaller percentage of that was actually utilized, according to the CSE’s State Of India’s Environment 2017.
The lack of adequate healthcare workers who can carry out a prevention programme on a war footing is also a challenge. This includes not just field workers but also entomologists who can research all aspects of vector populations and recommend how these can be kept below the “critical mass”.
The prospects for vaccines against vector-borne diseases seem to be poor. In India, the International Centre for Genetic Engineering and Biotechnology has been working on a malaria vaccine for at least a decade but it is not ready for clinical trials yet. A dengue vaccine that is being used in about a dozen other countries is not yet allowed in India.
Other problems include access to conflict-affected tribal areas, and to areas with a high malaria endemicity and insecticide resistance. High endemicity states include those in the Northeast, which share borders with neighbouring countries like Bangladesh, where the prevalence of malaria is high.
Fighting vector-borne diseases is not easy:
Least of all in a place like India that is a breeding ground for at least six major vector-borne diseases—malaria, dengue, chikungunya, filariasis, Japanese encephalitis and visceral leishmaniasis. As pathogens travel across continents and new strains continue to emerge, the fight against vector-borne diseases has, once again, become a global public health challenge.
From the 17th through the early 20th century, vector-borne diseases such as malaria, dengue, yellow fever, plague and typhus routinely wreak havoc on entire populations. Since the 1970s, many of the diseases have resurfaced, with even greater intensity in recent decades.
What has resulted into resurgence of vector-borne diseases:
While there are many different factors, local and global, that have contributed to the resurgence of each pathogen, two common factors that have impeded response strategies are:
The diversion of financial support and subsequent loss of public health infrastructure, and
The reliance on quick-fix solutions such as insecticides and drugs.
Lessons from past:
In India the early success of the anti-malaria programme led to a certain amount of complacency. India’s relatively successful anti-malaria programme, “depended too much on the efficacy of DDT (dichloro-diphenyl-trichloroethane)” and assumed that “there would be no further need for entomologists in mosquito control work”—hence, researchers were moved to other tasks such as family planning, funds were diverted, and only a small field staff was engaged in DDT spraying. This was a huge mistake: When malaria and other vector-borne diseases resurfaced, India was found unprepared. These are some important lessons from the past that we must keep in mind.
Intersectoral coordination is the key, ministries and municipal corporations will have to work together achieve the desired result.
Harnessing innovation and research along with monitoring is required.
For the first time, the Union Health Ministry has come up with a roadmap for elimination of malaria in the country. Before this, the effort was to “control” malaria under the National Vector Borne Disease Control Programme. Thus the plan needs to be implemented effectively if India is to translate its demographic dividend into an opportunity, as the more healthy Indian are, the healthier India will be.
Connecting the dots:
The government has recently launched National Strategic Plan for Malaria Elimination. Discuss its objectives. Also elaborate on implementational challenges.
TOPIC: General studies 2:
Development processes and the development industry- the role of NGOs, SHGs, various groups and associations, donors, charities, institutional and other stakeholders
Government policies and interventions for development in various sectors and issues arising out of their design and implementation.
Democratic state needs a democratic civil society and vice versa
Members and representatives of civil society organisations have expressed deep concerns on how civil society organisations and their donors are being labelled and targeted.
They allege that their funds are frozen, intelligence reports were selectively released to paint NGOs in a poor light, and their activities are placed on a watch list (terming their activities as anti-national in some cases).
By the end of 2016, the Union Ministry of Home Affairs rejected the licence renewal applications of 25 non-governmental organisations (NGOs) under the Foreign Contribution (Regulation) Act, 2010 (FCRA), which means that these NGOs can no longer receive funds from foreign donors.
As a result, NGO projects have been shut down, donors are unable to support work, and there is an overall atmosphere of State coercion and intimidation in the space of civil society.
Violation of democratic rights
NGOs and CSOs activities include – working for the poor and the marginalized, might involve questioning and protesting decisions taken by the government. There were instances where some CSOs and NGOs disagreeing certain government policies, for instance, opposing nuclear power plants, instances of campaigning to the right to food etc.
Members and representatives of civil society organisations advocate that it is the right of the democratically elected government to protect the right of the citizens to protest. However, by targeting them as anti-nationals, they emphasised that the government was violating two democratic rights: the right to freedom of expression including the right to protest, and the right to form associations.
Civil society as the sphere of associational life forms the backbone of democracy. Apart from right to participate in elections, citizens have the right to scrutinise the work of their representatives, publicize acts of omission and commission, such as infringement of civil liberties, appropriation of tribal land for purposes of accumulation, failure of governments to provide a reasonable standard of life for the citizens, and engage with leaders on the troubled issue of political conflicts. The right to engage with, interrogate and criticise representatives is an integral part of democracy. Without this right, democracy becomes farcical, an empty term, a phantom concept, an illusion.
Democracy beyond elections
Democracy is ultimately not only about the rights of the people who vote representatives into power but also right to speak back to abuse of power. There has been too much emphasis on democracy as elections in India. The heat needs to be taken off elections. There is a need to be conscious of what happens between elections, given the opacity of government, given its awesome power over the lives and liberties of citizens, and given the propensity of every government to appropriate, accumulate and misuse power. This can be checked, provided we appreciate the competence of ordinary people to participate in political campaigns in civil society.
Rise of civil society
The focus on civil society dates back to the 1980s, when political scientists began to speak of a ‘crisis of representation’. Citizens across the world had shifted from older and traditional forms of representation, such as political parties and trade unions, to ‘newer’ modes: social movements, informal citizen groups and non-governmental organisations.
The worldwide shift to civil society was catalysed by the mobilisation of people against Stalinist states in Eastern and Central Europe in the 1970s and the 1980s. Citizens turned their back on unresponsive and authoritarian states and formed associations, such as reading clubs and soup kitchens, in a metaphorical space outside the state. This space they called civil society, a companion concept to democracy.
In India, by the late 1970s, the decline of all institutions gave rise to several mass-based political movements and grassroots activism. The anti-caste movement, the struggle for gender justice, the movement for civil liberties, for a sound environment, and against mega development projects that have displaced thousands of poor tribals and hill dwellers, the movement against child labour, for the right to information, for shelter, for primary education, and for food security have mobilised in civil society.
The fact that vital issues related to livelihoods, to the fulfilment of basic needs, and for justice were not taken up by political parties but by civil society organisations acted to propel hopes in civil society as an alternative to the non-performing state and an unresponsive party system.
In the first decade of the 21st century, civil society organisations stepped in to represent the interests of the most deprived and the most marginalised in the country. Mobilisation proved effective, and the enactment of social rights followed a number of civil society campaigns, the filing of Public Interest Litigations in the Supreme Court, and the onset of a new phase of judicial activism.
However, today, we see the marginalisation of civil society and the sidelining of a rights-based approach to social policy.
From 2004 to 2014, civil society organisations came together to press upon the government the right of citizens to social goods. Once laws granting the right to information, to food, and to work had been passed, activists kept watch on acts of omission and commission, and issued citizen reports.
Today, social security plans are announced without corresponding mobilisation of, consultation with or intervention of civil society organisations. On the contrary, the government has come down heavily on organisations by blocking their bank accounts, by putting a stop to funding, and by casting aspersions on their ability to represent the people of India. In many instances, non-governmental organisations such as Greenpeace have been projected as being anti-national.
A democratic state needs a democratic civil society. But a democratic civil society also needs a democratic state; a state that respects the politics of ‘voice’ as opposed to the politics of the ‘vote’. If the government respects the voice of citizens through the grant of the right to freedom of expression and association, it should be enabling civil society to articulate aspirations, critically engage with the state, and issue social report cards. The promises of democracy can only be realised through collective action in civil society. If the state constrains civil society space, democracy is truncated, and citizens are seen only as voters. They are deprived of status.
Civil society and voluntary sector occupy a prominent place in the democratic landscape of India. Their contribution in helping the state reaching out to the poor and giving voice to the common citizens can’t be overstated. However, rule of law must govern their functioning in matters of financing and objectives.
Connecting the dots:
Is the government decision to restrict activities of NGOs and CSOs a violation of freedom of speech and expression? Evaluate in light of recent developments.
Civil society and voluntary sector occupy a prominent place in the democratic landscape of India. Their contribution in helping the state reaching out to the poor and giving voice to the common citizens can’t be overstated. However, rule of law must govern their functioning in matters of financing and objectives. In light of the controversy and debates surrounding the voluntary sector, analyse the statements given above.
Do you think civil society has a role to play in law making? In a democracy like India, what role would you envisage for the civil society in legislative functions? Discuss by citing examples from the recent past.