'TB, malaria, kala-azar form 30% of India's disease burden'

Innumerable other diseases which are not targeted through donor-driven programmes, including cholera and typhoid fever, are neglected and poorly monitored, medical journal 'Lancet' says in its series on India.

India's public health care system is overwhelmed by the infectious disease burden, driving many families to use the private sector, where the costs of treatment are crippling.

Only a few infectious diseases are prioritised in the vertical control programmes managed by the central government, and even among these diseases only the control of HIV and leprosy seems to be successful but not that of diseases such as tuberculosis, malaria and visceral leishmaniasis (kala-azar), the journal said in an article written by health experts T Jacob John and Vinod P Sharma, among others.

The authors say that case-based disease surveillance, generated through healthcare personnel in the public and private sectors, and public health response at the district level as part of a functional public health infrastructure are urgently needed for effective control of all infectious diseases.

The article goes on to say that the public-sector healthcare network is overwhelmed with preventable morbidity from infections and other diseases, encouraging growth of largely unregulated private commercial healthcare that entails large out of pocket expenditures by families.

For a formal cadre of public health personnel at district, state and national levels, reorganisation of the system and adequate training programmes will be necessary to control infectious diseases and link this effort with control of increasing burden of non-infectious diseases and injuries that are already major causes of death and economic illness.

It said that the Public Health Act of 1897 has not been amended and hence notifiable diseases are generally not reported. A real time, efficient, and inexpensive surveillance of diseases in districts that are prone to outbreaks and are targeted for control in both public and private sector hospitals has been successfully field-tested.

Another potential source for infectious diseases is the diagnostic laboratory. However, primary and secondary public sector health-care networks have no access to microbiology laboratories, it said.

Civil law requires death registration before cremation or burial but rural authorities often ignore it, say the experts. Over 70 per cent of deaths occur in houses and two-thirds do not register their deaths.

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