Malaria No More is a nonprofit that aims to eradicate the disease. Founded in 2006 in the US, the organisation has affiliates in India, Japan and the UK, and has mobilised political commitment, funding and innovation to rid the world of malaria. In an interview, MNM's India director Pratik Kumar talks about where the country stands vis-a-vis malaria eradication.
Q. What are the avoidable mistakes that could lead to the breeding of malaria-causing mosquitoes?
A. There are two types of people. One is the well-educated class, which knows of preventive methods but continues to do things that lead to proliferation of mosquitoes. We see them keeping their houses clean, but outside it can be as dirty as possible. In high societies, you don’t see stagnant water, but there are enough places—the corner of an AC or some patch somewhere or something that is constantly leaking—to cater to the egg-laying.
Then there are tribals, migrant workers, people who sleep in the open, or have lived in such conditions that if they get bitten by a mosquito, it is not going to impact them. That is because, at a young age, if you get exposed to mosquitoes, that buzzing sound doesn’t bother you, and even if it bites, you manage to sleep through it.
So one has to be alert about the mosquito density in a place and the ways to protect oneself. Anopheles mosquitoes [that transmit malaria] can smell a person from 100 feet. People have to create barriers for it using coils, sprays and other repellants.
Q. You have worked on the ground. How has your experience been?
A. People who have low access to quality health care are the ones who suffer. There are hills, forests and other inaccessible terrains where health workers find it difficult to go and test people. By default, the chances of malaria being eliminated in these areas are low.
Q. What needs to be done to eliminate malaria by 2030?
A. The biggest challenge is that we don’t even know who all are carrying the parasite. There are two reasons for this. The first is the way the country accumulates data around malaria, which is through the public health system. Second, the private sector does not report data because there is no system wherein it can notify this. In India, on average, the national family health survey says that 70 per cent of people go to the private sector for treatment.
The Accredited Social Health Activists (ASHAs) and Auxiliary Nurse and Midwives (ANMs) report malaria. If one has fever, he/she can go to an ASHA, who will potentially run a malaria test on the person. It’s possible only when the ASHA has a rapid test kit, and some of these blood samples are taken to labs for further information. This whole system is quite weak. If someone tests positive, ASHAs and the labs report, and then, from the ground report, the system collates data at various levels—up to district, state and national level. ASHAs record the findings using pen and paper, and by the time it comes to district level, it potentially becomes computerised. There is a huge lag. If we have to address an immediate malaria outbreak, we cannot afford this lag. At present, we have a monthly reporting system. So we are just trying to control malaria right now, not eliminate it. It is a disease for which even the government is not willing to take enough action.
Q. How do you report malaria cases and deaths?
A. Our reporting goes to the primary and community health centres. India is a big country; we have worked in only 263 villages, but we do get a lot of information. We have heard about a lot of deaths, but those do not get reported because there are administrative issues involved in the system.
Another thing that needs attention is asymptomatic malaria, because the parasite inside one’s body causes all the damage—from breaking off the red blood cells to making a person anaemic, malnourished and so on. This is a huge problem that the Centre does not even recognise.
Q. With such few resources, how can malaria be eliminated?
A. Every November, the WHO comes out with a World Malaria report, in which the number of cases are five-to-10 times higher than the number the Indian government reveals. The government usually trashes the WHO report. We, as civil society, have the figures for rapid diagnostic test (RDT) kits, and the medicines sold for malaria. The medicines sold are 100 times the number of cases. So the sales figures tell a different story, WHO says something else and the government doesn’t say much.
Interestingly, the health ministry recognised that the private sector reporting is good for HIV and tuberculosis, but no heed is being paid to malaria.
So far, we haven’t got the sense that the government has really shown the urgency to achieve the goal of ensuring zero malaria cases. All sectors also have to come forward together to eliminate malaria. It has to be a people’s movement.