· In 2005, there were over 1.8 million Microscopically Diagnosed Positives (MDP) cases of malaria in India and 963 reported deaths caused by the disease. The actual number of cases taking into account those undiagnosed is likely to be substantial.

· While funding commitments for malaria control increased markedly from $0.3 billion in 2003 to $1.7 billion in 2009, this is still way short of the $5 billion needed annually.

· Around 80 percent of external funds go to Africa. Southeast Asia saw the least money per person at risk for malaria and the smallest increase between 2000 and 2007.

· Funds are disproportionately concentrated on smaller countries with lower disease burdens. Large countries like India and China Countries are particularly disadvantaged with respect to receipt of external assistance partly because the populations at risk are estimated less precisely.

· The progress of India in reducing the number of malaria cases between 2000 and 2008 is greater than 25 percent but is way behind countries like Sri Lanka, Thailand, Nepal and Bhutan that have achived more than 50 percent reduction.

Source: World Health Organization (WHO)WHO, Malaria Report, 2009 http://www.searo.who.int/LinkFiles/Malaria_Profile_India.pdf

Half of the world’s population is at risk of malaria, and an estimated 243 million cases led to an estimated 863, 000 deaths in 2008. There are, today, tools with which a malaria diagnosis can be made even at the community level, and very effective medicines for the treatment of uncomplicated malaria. Despite this, Malaria continues to inflict suffering on a huge number of people.

India initiated the Integrated Disease Vector Control Project in the early 1980s under Science and Technology Mission. The project was assigned to be implemented by the Malaria Research Centre, now renamed as the National Institute of Malaria Research (NIMR). Currently malaria control heavily relies on the integrated methods that include mass production and distribution of larvivorous fishes, insecticide-treated bed nets, bio-larvicides, repellents, mosquito proofing of water storage and water harvesting structures, management of malaria in pregnancy etc. These are complemented by scientific research on health impact assessment, clinical trial of new drugs and combinations and such measures as amendment of urban by-laws, health education programs. http://www.mrcindia.org/idvc-profile/m.pdf

Unfortunately, like many other diseases, the burden on the poor is the most. Given that Malaria is often a problem in concentrated areas and the cost of intervention is low, it is easier to intervene in terms of programs (though often the terrains are difficult). While there might be low external funding, India should be able to mobilize and use its domestic finances to fund the program. Unless it is prioritized, Malaria eradication would remain a distant dream and would continue to cause avoidable suffering.

Is Malaria control and prevention high on the government’s agenda?

According to World Health organizations (WHO), most of India’s estimated 1.2 billion people have to pay for medical treatment out of their own pockets. One of the major reasons that India’s poor incur debt is the cost of health care. Given that the government share of health spending is low, out-of-pocket payments are the dominant source of health financing.A 2009 report by the Federation of Indian Chambers of Commerce and Industry states that less than 15% of the population in India today has any kind of health-care cover, be it community insurance, employers’ expenditure, social insurance etc. (Source: http://www.who.int/bulletin/volumes/88/7/10-020710/en/index.html).

In this context, initiatives such as the National Health Insurance Scheme offer some relief for the poor. About 75% of the financing for this scheme is provided by the national government, the remainder by state governments. The scheme aims to protect households living below the poverty line from liabilities arising from hospitalization. Beneficiaries are entitled to up to Rs 30,000 of cover for most of the diseases that require hospitalization. Coverage extends to five family members, including the head and spouse and up to three dependents. The central and state governments then pay the premium to the insurer, which is selected by the state government. Every beneficiary family is issued with a biometric smart card that stores members’ fingerprints and photographs. The National Health Insurance Scheme has distributed more than 15 million smart cards across 26 states.

However, to assume that this is an adequate intervention to bridge the demand and supply of health care would be to show complete ignorance about the realities. To begin with, the scheme does not cover out patient services which means that the poor still pay out of their pockets for everything that does not require hospitalization. In excluding outpatient services, the scheme leaves out one of the most important components of health care and excludes a huge section from the program. In real terms it means, one is still without support when down with gastro-enteric diseases, for example, one of the most common health problems. Further, when one has to be hospitalized, then the cost of treatment (which usually involves surgery) often exceeds Rs 30,000. Also, given that most of the rural areas do not have hospitals equipped with infrastructure and medicines, who pays for the transport to bring the patients from the remote areas to the cities? Who reimburses the care givers for the lost wages?

These are important questions that need to be answered. It is not very difficult to have a policy on paper. However, for the policy to be useful to the people, especially to the poor, it has to be more serious and sincere to reach out to the people who really need support. It needs to be recognized as a social security program for the poor and a safety net.

What should be done to make the health insurance program for the poor more inclusive?