How does India fare in progress against malaria and tuberculosis (TB)? Poorly, according to the United Nations (UN).
India’s progress in achieving health goals was deemed “dismal” by the 2018 global Multidimensional Poverty Index (MPI), released by the United Nations Development Programme (UNDP). It scored the worst among the four Asian nations in the middle-income group — the others being Bangladesh, Pakistan and Myanmar. The UN report claims as many as 18.8 persons per 1,000 people live in high malaria transmission areas in India. Bangladesh has the least, with only 0.6 per 1,000 people living in such areas. Pakistan and Myanmar fall in the middle ground, with 10.6 and 7.2 respectively.
While this figure may seem unimposing, for India this translates as hundreds of millions of individuals in high-risk areas — simply due to India’s considerable population.
While this figure represents high-risk areas, very few regions of India can truly consider themselves free of malaria. In these cases it is often simple geography that frees them of the disease, with the high altitude areas (above 2000m/6561ft) of Himachal Pradesh, Jammu, Kashmir and Sikkim being considered risk-free.
India fares slightly better compared to its neighbours in regards to TB, with only Nepal showing fewer disease cases. In India, TB affects 211 people per 10,000 people exposed to the disease. The report included both new cases and cases in which TB had relapsed. Comparatively, Nepal showed only 154 cases per 10,000 people. Pakistan and Myanmar both showed higher rates of TB, with 268 and 361 cases per 10,000 respectively.
The report attributes India’s high burden of malaria and TB — despite comparative economic strength compared to its neighbours — to a lack of investment in its healthcare budget.
The lack of a strong healthcare budget to tackle healthcare goals has been acknowledged by many within India. “There is still a long way to go before the target of public health expenditure is achieved and the central allocation for health for 2019-20 was far short of target,” said the Comptroller and Auditor General of India recently.
India is facing a growing double-burden of disease. Historically, infectious diseases dominated the overall number of deaths in India. Progress has indeed been made in addressing these conditions; however, sustained public spending is needed to ensure resurgences do not occur, particularly when it comes to diseases eliminated but not eradicated in the country such as leprosy. India continues to shoulder high burdens of communicable conditions such as HIV/AIDS.
Whilst efforts to control them have borne fruit, infectious diseases such as malaria and TB have rapidly been overtaken by noncommunicable diseases (NCDs) such as heart disease and cancer as the most prevalent and lethal conditions in India. These conditions are becoming ever more widespread, and are placing a significant strain on the health budget. Should investment not occur in the near future, India may begin to fall back further in their aims to reach their healthcare goals.