Goal 1:Reduce child mortality reduce by two-third, between 1990 and 2015, under-five mortality rate.
Goal 2:Improve health reduce by three quarters, between 1990 and 2015, the maternal mortality ratio.
Goal 3:Combat HIV/AIDS, malaria and other diseases halt by 2015 and begin to reverse the spread of HIV/AIDS and reverse incidence of malaria and other major diseases.
These three goals are compendiously referred to as Health Goals. Going by the findings given in the Human Development Report 2003, the scale of the problem is humungous. The broad reasons why solutions of these problems remain out of reach for millions of poor people are (i) limited resources; (ii) inequality; and (iii) inefficiency.
Developed countries spend at least 5 per cent of their GDP on public health care. In countries which rank low in the human development index, the expenditure is 2.1 per cent of GDP. In India, the expenditure on health comprises 5.2 per cent of GDP with public health investment at only 0.9 per cent. Two of the major diseases are malaria and leprosy. As recently as 2001, 2.03 million cases of malaria were reported. The goal is to bring about a 50 per cent reduction in mortality due to malaria by 2010.
The prevalence rate of leprosy was 3.36 per 10,000 in September, 2002. The goal is to eliminate leprosy by the end of 10th Five Year Plan (2007) bringing the prevalence rate to less than 1 per 10,000.
The other problem is blindness. Out of the total estimated 45 million people who are blind, 7 million are Indians. 82 per cent of the blindness is caused by cataract and refractive errors, both remediable by proper treatment. The 10th Plan goal is to clear the backlog of blindness due to cataract.
The most serious health problem facing India is HIV/AIDS. A nationwide surveillance conducted in 2001 revealed that total number of HIV infection in the country was 3.97 million. Six states have been identified as high prevalence states. These are Karnataka, Tamil Nadu, Andhra Pradesh, Maharashtra, Manipur and Nagaland. The goal is to achieve a zero level of growth for HIV/AIDS by the end of the 10th Plan period (2007). It is difficult to feel good when there is so much disease around us. Some of them continue to be prevalent in epidemic proportions. The most frightening problem is the spread of HIV/AIDS.
The AIDS virus was discovered in 1983. Twenty years of research has yielded medicines that keep the virus under control, but there is not yet a cure for the disease. There is no vaccine. Pharmaceutical companies are offering new drugs to fight HIV/AIDS. Each one of them is extremely expensive and beyond the reach of the poor everywhere and beyond the reach of the public health systems of developing countries. For example, Roche, a pharmaceutical major, introduced last year (after spending over $600 million) a new class of medicines known as fusion inhibitors. It is reported that manufacture of these drugs required over 100 separate steps and 45 KG of raw materials will yield 1 KG of the drug. The drug route to fight HIV/AIDS effectively is a long and tortuous route and beyond the capacity of poor countries or poor people.
So far, 60 million people have been infected by HIV/AIDS worldwide and more than 25 million people have died. In 2002, it was estimated that 42 million are living with HIV/AIDS. Sixteen thousand new infections take place each day. Of these, children living with HIV/AIDS is estimated at 3.21 million. Eight lakh children were infected in 2002 and more than 610,000 children died due to HIV/AIDS in 2002. The socio-economic impact of HIV/AIDS goes beyond the health of the affected individual. There are multiple impacts at the household level, there are costs to business and there is reduction of economic growth.
How can a developing country like India respond to the challenge of HIV/AIDS
No one questions the need for indigenous research and development, but there should not be high expectations in this behalf. If one drug researched by Roche will cost $ 600 million, we can imagine the huge expenditure involved in research and development. The more cost effective answers in a third country appear to be an awareness campaign and prevention. There is now an awareness campaign in some states. In fact, the campaign revolving round a mythical character named Pulli Raja has kicked off a controversy in some States. Yet, the impact of the campaign cannot be under-estimated. The message is direct, blunt and some times even offensive, but the message is reaching the target. It is necessary to multiply the campaign several-fold to carry it to all parts of the country.
The second part of the answer lies in prevention. Prevention means use of condoms. Somehow, condom usage is still shrouded in secrecy. At one point of time, the health minister even frowned upon certain explicit public health messages on the use of condoms transmitted through television. Her approach should have been the exact opposite. Instead of being squeamish, she should have urged the public health authorities to be more explicit and use television more extensively.
I think it is time that the condom is brought out of the closet. The taboos about sex are lifting, but the taboo about explicit references to condom continue. If there is more discussion about sex, there should also be more unrestrained references to condoms. The problem about use of condoms, especially in rural areas, turns around awareness, availability, access and affordability what are called the four As. Governments should step up the awareness campaign and the manufacturers and distributors of condoms must ensure that they are available in the remotest villages. If they are available, people will be able to access them. Affordability is not a big issue. Governments must also make free supplies to certain target groups. So it comes back to an awareness campaign and making condoms available in all parts of the country.
Just as the Prime Minister has adopted the golden quadrilateral as his pet project, he should adopt the mission of fighting HIV/AIDS through prevention as his pet mission.