Stumped by dengue
DURING one of his campaigns in Asia, in the midst of a hot and humid summer, Alexander the Great fell ill with a mysterious disease. His army, fatigued and demoralised, beat a hasty retreat. Suffering seizures and high fever, Alexander succumbed to his illness at the young age of 33. Modern research suggests that he may have contracted malaria, a disease common in the Mediterranean and Asia.
Although the parasite responsible for malaria has been in existence for 50,000 to 100,000 years, it was not discovered until the 20th century that the disease is transmitted to humans via the bite of the tiny Anopheles mosquito. Throughout history, millions have succumbed to this scourge, and despite advanced medical research, malaria and other vector-borne diseases continue to hamper progress in developing nations. Vector-borne diseases are carried from one person to another through a third organism, such as a blood-sucking insect, eg a mosquito.
According to a World Bank study, rising temperatures and humidity levels are likely lead to an increase in vector-borne diseases including malaria, dengue, yellow fever and encephalitis. According to WHO, in 2015 there were 212 million cases of malaria and 429,000 malaria deaths worldwide.
KP’s health sector reforms are under threat.
However, the world’s fastest growing vector-borne disease appears to be dengue haemorrhagic fever, which has surged 30-fold over the last 50 years. Studies predict that an increase of three to four degrees Celsius in average temperatures may double the reproduction rate of the dengue virus.
From 2005 onwards, Pakistan has seen a spike in the incidence of dengue fever. Since 2010, there have been 16,580 confirmed cases including 257 deaths in Lahore, and approximately 5,000 cases and 60 deaths in other parts of the country. The current epidemic in KP has claimed about 30 lives within a month.
Evidence indicates that the entire country is prone to dengue epidemics because of unpredictable climate patterns. Vulnerable communities living in poverty in slums and suburban areas without adequate housing, potable water and proper sanitation, and with limited access to health facilities are likely to suffer the most.
The present dengue epidemic has overshadowed the otherwise outstanding performance of the KP government in the health sector. Consider some positive reforms in this sector:
One, health financing through the Sehat Insaf Card and Sehat Sahulat Programme are leading pro-poor initiatives of the provincial government that cover all districts and have achieved 60pc targets in the first two years of implementation. This is a feather in the KP government’s cap that even its detractors cannot deny.
Two, the health sector budget has gone up from Rs18 billion in 2012-2013 to Rs.65.7bn in 2017-2018, an unprecedented infusion of funds. While Pakistan’s per capita spending on health remains 1pc of GDP, KP’s is 6pc of GDP.
Three, the scale of multidimensional reforms is enormous as are investments in infrastructure, human resources and medicines, and inductions in the health cadres at every level. Moreover, these cadres have been upgraded, regulatory and reporting structures for uniform quality service delivery enhanced, and long-term investments made in primary, secondary and tertiary care. All these developments provide a safety net for vulnerable sections of the population.
However, despite these sweeping reforms in the KP health sector, the battle between public health and curative health has never been more acute. While preventable (infectious) diseases have not yet been eradicated, lifestyle (chronic) ailments such as cardiovascular disease, diabetes and obesity are adding to the health burden.
Healthcare professionals and public health officials tasked with preventable diseases need more resources, restructuring and research to tackle emerging crises like dengue fever. Active advocacy in primordial, primary, secondary and tertiary prevention can go a long way in reducing the burden of disease as well as put less pressure on scarce health resources.
Building academic linkages for research, analysis of health trends and evidence-based policy decisions are a practice in the developed world. Currently, all health departments, water and sanitation and other line departments in the province work in silos and need a more collaborative approach as envisioned in the Sustainable Development Goals 2030.
Climate change is an emerging global threat impacting health and endangering lives, signalling a phenomenon that is certain to affect larger populations in the future. The public health principle, prevention is better than cure, can no longer be taken for granted.
The dengue epidemic has the potential to stamp out ongoing reforms in KP’s health sector — similar to the malaria mosquito parasite that may have been responsible for cutting short the life of one of the greatest warriors in history.
The writer teaches public health.
Published in Dawn, September 27th, 2017