EDITORIALS

Outbreak of Politics
Each outbreak of dengue shows no lessons have been learnt.

he official and public response to the ongoing outbreak of

dengue in Delhi, Mumbai and other places in India have
been marked by features that could well be categorised as
how not to deal with a disease outbreak. The Bharatiya Janata
Party (BJP) Central Government and the Aam Aadmi Party
Government of Delhi have been flinging allegations at one another
while extolling their own efforts even as private hospitals seem
to be almost rubbing their hands in glee at what the public panic
means for their coffers. One major hospital chain even went to
the extent of offering insurance for dengue.
Despite the seemingly inexhaustible media coverage, or rather
because of it, the clamour for admission into hospital for every
patient with fever has led to hospital beds being unnecessarily
occupied. And yet, healthcare activists find that public awareness
about the disease and what really constitutes preventive care and
the first line of treatment is abysmally low as is the public health
systems ability to cope with the large number of cases. The other
bugbear, of poor data collection and methodology, has only made a
messy situation worse. All in all, it is difficult to believe that India
has been witnessing such dengue outbreaks for more than two
decades now and there are few signs that lessons have been learnt.
The Indian Medical Association (IMA) as well as several state
governments have been appealing to the public not to panic.
But these appeals have had little impact in the face of piecemeal
media reports and knee-jerk public-health responses. The death
of a seven-year-old boy in Delhi, after his parents were reported
to have gone from hospital to hospital seeking admission and
their suicide later, led to a war of accusations between the central
government and the Delhi government last month. The media,
only too happy to stoke the already simmering rivalry between
the two, faithfully reported the allegations. Incidentally, the BJP
is also the ruling party in Delhis municipal corporation. Even as
each side claimed that it was rising above the politics, the
atmosphere created could hardly have generated public confidence. Politicians everywhere berate the media for exaggerating
the dengue outbreak and not reporting properly on the measures
their administration is putting in place to deal with it.
Meanwhile, government and private hospitals and doctors
have been reporting that the demand for hospital beds is leading
to frayed tempers and near-chaos in these places. In all this

sound and fury what is lost count of, say doctors, is the misplaced
importance given to the platelet count. In a number of viral
infections the platelet count drops but that in itself is not an
indication of an emergency and the majority of dengue cases can
be managed at home with the standard treatment being adequate
hydration through ingestion of fluids. The oft-heard allegation
of panic-mongering by private hospitals is not countered by
sustained and systematic public awareness campaigns.
Another factor that has often been named but neglected is the
emphasis on surveillance data. In fact, the prevention and control policy demand has consistently called for strong surveillance, proper training of public health field staff and the need
for community participation. In fact, appeals to curb panic are
juxtaposed with media reports that say that while the union
health ministry says that an average 20,000 cases of dengue
were reported every year from 2006 to 2012, two other studies
put the figure between six and 44 million and that there is massive
underreporting, to put it mildly. It follows that such confusion
over data can only have an adverse effect on any kind of planning and policy implementation. The National Health Profile
figures released to the media recently said that in 2014, the cases
of dengue reported stood at 40,425 with 131 deaths across the
country. The union health ministry reported that until September,
this year alone saw 27, 668 cases with 60 deaths.
The ills of Indias public health system are a familiar story
with analyses of what ails it being pointed out repeatedly. Over
the years, health activism has taken on a prominence it did not
enjoy earlier in this country. There are a number of issues that
need vigorous and sustained focus. Among these is foremost, an
engaged political and bureaucratic leadership of public health
services and programmes, a functioning regulatory mechanism
to oversee the work of private hospitals, coordination between
state and central governments and greater attention to sanitation
and garbage disposal. It has often been pointed out that India
spends very little of its resources on public health as compared
to most other countries, many of them far poorer than this putative superpower. It is high time our political class realised that
instead of bickering over accusations and credit-taking during
each crisis, they should pay greater attention to what constitutes
the favourite slogan of health for all.

SEPTEMBER 26, 2015

vol l no 39

EPW

Economic & Political Weekly