Re: Bihar: Mandatory to report HIV/AIDS & MIS

[Guest guest]

Dear Geoff,

Thanks for your insighful commentary on your visit to

India. I fully agree with your comment: " One of the

things that stands out is the lack of effective

monitoring of Infectious Diseases in India " .

Unfortunately, that is not only for want of systems.

Actually, there is quite an elaborate Govt.-driven MIS

for infectious diseases in place (in all the states of

Indian Union) that was supposed to generate the 'real

numbers' of common infectious diseases with age-groups

and geog locations of people involved. This MIS is

'generated' from the grass-roots Primary Health

Centres (Govt. funded and run) all over India and

routed through the district and state levels right up

to the Central Govt (Ministry of Health) level.

Unfortunately, that MIS document is filled-up by

indifferent staff whenever they feel like and with

what ever numbers they feel like! And so the picture

of not having reliable epidemiological data on

infectious diseases. Also it is sad that this sorry

state of data generation is not restricted to the

'poor' or 'difficult' states only, but is a national

phenomenon. I have worked both with the Govt. of West

Bengal in rural health and with the Govt. of Bihar as

a WHO Polio Surveillance Medical Officer, and that is

what I saw in each PHC or community health centre that

I visited in line of duty.

Just chew on this: India

had had universal immunisation program for the 0-5

year age group in place since 1985. When the Govt. of

India decided to eradicate polio, they realised after

the first few rounds of NIDs that they did not have

any reliable data on the number of children still

being affected by polio and the geographical

locations/clusters of cases. Neither did they have any

reliable data regarding the effectiveness of the

vaccination programs that were being run! And until

the WHO stepped in with a polio surveillance program,

no genuine data could be generated for the whole of

the country!

Besides this another serious hurdle is the utter

disregard of the private health care system (in form

of pvt practitioners and pvt hospitals and nursing

homes) to report infectious diseases to

town/city/district/state authorities. Having

interviewed some of these people in line of duty, I

have a feeling that they couldn't care less - as long

that long line of waiting patients continued coming

their way! In additon, is the issue of the vast number

of unregistered practitioners all over India (at all

levels including in the metropolitan cities) who have

been so 'looked down' upon by the 'offical' health

care providers (both govt. and pvt.) that they would

never bother to inform authorities on even the

suspected cases that they see! (As an aside, last year

an unregistered practitioner was requested to report

suspected polio cases in one district in West Bengal -

by the end of the year he had single-handedly reported

upwards of 12 cases of confirmed polio - and thereby

proved wrong the West Bengal govt.'s claim that they

did not have a polio epidemic in the state!)

These are just a few of the real 'hurdles' India has

in collecting reliable infectious disease data and

these hurdles exist even for the 'public' diseases

like malaria, measles, diarrhoea, hepatitis, acute

respiratory infections, etc. Just imagine what it is

like for the 'hidden' diseases like TB, leprosy (both

of which, in spite of effective and free govt. tests

and treatments available nationally, are cause for

stigma and discrimination), STIs, 'women's diseases'

and (the unmentionable of unmentionable!) HIV/AIDS!

Hope this provides further food for thought.

Warm regards,

Amitrajit

Dr. Amitrajit Saha MD

Advisor,

DURBAR

12/5 Nilmoni Mitra Street, Kolkata 700006

Ph +91 33 5437451 / 5437560

Fax +91 33 5437777

Ph (H) +91 33 4651133

E-mail: amitrajitsaha@... & amitrajitsaha@...