However, it also stands out for its colossal neglect of some basic factors---such as health.
For instance, Bill Gates recently made an embarrassing comparison of India with Ethiopia. The African country, he said, was reportedly terrible 10 years ago. However, it has become very good today, and continues to improve due to efficient surveillance systems. Worryingly, the world’s problem areas include parts of India, Pakistan, Nigeria and the DRC, he said.
The Gates Foundation
To streamline processes, the Bill and Melinda Gates Foundation recently launched the Child Health and Mortality Prevention Surveillance Network, or CHAMPS. It is putting some special focus on improving the structure and getting systems into place, said Bill Gates, to The Atlantic.
For instance, it is not clear why neonatals die, yet their project is trying to probe the drivers of mortality for all children. The Gates announced that they are investing $75 million in a number of surveillance sites expected to collect information "about how, where and why children are getting sick and dying.” The plan will be spread first through six nations in Africa and South Asia, depending on field workers to take the autopsies of children who have died, especially in “beefed-up laboratories.”
Disease surveillance system
The Integrated Disease Surveillance Programme (IDSP) was launched in India with the support of the World Bank in November, 2004, so that the country could detect and respond to disease outbreaks quickly. In March 2010 to March 2012, World Bank funds were made available for Central Surveillance Unit as well as nine identified states (Uttarakhand, Rajasthan, Punjab, Maharashtra, Gujarat, Tamil Nadu, Karnataka, Andhra Pradesh and West Bengal). The other 26 states were funded only by local budgets.
The Surveillance Programme will continue well into the 12th Plan (2012-17) under the National Health Ministry, with an outlay of Rs 640 crore from the domestic budget.
The World Bank’s focus was to strengthen the system for epidemic-prone diseases, improve central monitoring and coordination, improve state and district surveillance focusing on nine states, gear up and prevent influenza epidemics.
Findings of the project
The project seemed to have detected a few parameters for progress in surveillance as well as in identification and response, related to IDSP and also assessed the infrastructure and systems in place. A number of future goals have been evolved to improve the public health information and intervention.
Only recently, it was found that ratings for the Integrated Disease Surveillance Project (IDSP) for India were just moderately satisfactory. The survey factored the risks to development outcome, bank and borrower performance.
Unfortunately, Non-Communicable Diseases (NCDs), which should be a core, important public health function in India became part of the surveillance survey very late. The NCD risk factor was thus delayed and was improved only in some provinces, not countrywide. Ultimately, the country plans to integrate the NCD factor into the national programme.
The solutions to fight epidemics and diseases are distributed unevenly among different groups and communities, impacting socially and economically sensitive groups. Unfortunately, the inequitable system of distribution in India is glaringly evident in the implementation of the system.
Take TDAP (Tetanus, diphtheria and pertussis), for instance. At first, the programme was not implemented with efficiency. It was restructured only in 2010 in the nine “best performing states”, selected on the basis of their performance as well as administrative and reporting efficiency. It was an ironical conclusion, as the states that needed support lagged behind the most, yet got the least central assistance.
The twin outbreaks of dengue and chikungunya were a major public health concern and pain point a few years ago. The Aedes mosquito-borne chikungunya, with more than a million suspected cases in India, could be controlled by general hygiene and sanitation, but the disease was not shaken off due to the problems in the sanitation, hygiene and environment.
Amazingly, the health minister at the time, Anbamoni Ramadoss, actually commented that the health ministry can't do much in the job! “(We need) involvement of general public, the associations and the civil society," he said.
The centre cannot wash off its responsibilities, but the execution is too erratic. For instance, Andhra Pradesh has noted that a special sanitation drive was launched, including massive disease surveillance, to improve the vaccination system in its state. In Gujarat, traditional medicines have been harnessed to fight the disease.
The surveillance system reveals that a number of measures are being identified and put in place--for instance, deployment of trained personnel, appropriate technology as well as efficient administrative services. Establishing extensive laboratory networks are needed for careful investigation.
So far, the ratings of the system have been just moderately satisfactory. Hence, the nation should gear up and streamline the administration, which is crying out for attention.