'Include health safeguards in urban planning'

The outbreak of dengue and chikungunya in the country is a fallout of development without a regard for health safeguards, Dr P L Joshi, director of national vector-borne disease control programme, has said.

Whether it is Bharat Nirman, the prime minister's pet scheme for infrastructure development, or the private construction boom, it has to go hand in hand with health safeguards.

"We have to link vector control with development programmes like Bharat Nirman. Or, the result will be diseases. There is a national task force under the health secretary, but no one listens to it. Maybe the present crisis will make the other ministries take health seriously. This should be done at the district level, too," he said.

In fact, most of the causes of generation of mosquitoes are in the domain of departments other than health. And, none of them sought the advice of the health department when it came to handling sanitation, irrigation, or such issues, he said.

Dengue has so far swept across 19 states and claimed 3,900 victims, while chikungunya cases have been running into thousands in different states.

However, the states do not have any mechanism to combat such outbreaks. In states like Kerala, these diseases have been striking every year, but there are still no testing facilities there.

The union health ministry responded to the crisis in Kerala only after 90 deaths had taken place. "Where are the chikungunya kits? We have asked for kits from the National Institute of Virology to be sent to Kerala," Joshi said.

Another gaping hole in the public health framework is the shortage of qualified personnel to provide healthcare services. Virologist Jacob John told Business Standard: "It is probably the best kept secret that this country has few public health personnel."

Even as the authorities have been caught offguard by the outbreak of the diseases, the health machinery is not willing to term them an epidemic. Medical officials said this had more to do with politics than the situation on the ground.

According to doctors at the All India Institute of Medical Sciences (AIIMS), a disease is normally declared an epidemic on the basis of a statistical analysis of its spread and fatalities caused in the last several years.

"Even if one case of plague surfaces in the US, it can be declared an epidemic; but, the same may not be the case in India," Dr Shakti Kumar Gupta said.

"We can only treat the disease. Declaring it an epidemic is in the hands of the ministry and the government," a senior doctor at AIIMS said.

What stopped the government from declaring the outbreak of a disease an epidemic, doctors said, was the fear of shouldering blame for it.