sting operation

90% of malarial deaths happen in rural India

The economic burden of malaria in India is $1,940 million despite the government spending $51 million towards it in 2013.

Stagnant puddles, which are a breeding ground for mosquitoes, follow the rains every year causing an increase in the incidence of water-borne diseases. Malaria is the third most common of these diseases in India after diarrhoea and typhoid. In 2014, the number of malaria cases in the country rose to 10,70,513, up from 8,81,730 in 2013. 35 countries, India being one of them, contributes to 96% of the total malaria cases and 98% of the total malaria deaths in the world. India is also one of the three countries that accounts for 97% of the malaria cases in South East Asia.


Malaria in urban India

The maximum number of malaria cases in Indian cities are reported from Ahmedabad, Chennai, Kolkata, Mumbai, Vadodara, Vishakapatnam, Vijayawada and Pune thanks to increasing urbanisation, industrialisation, and construction projects. According to the Annual Report of the Ministry of Health and Family Welfare 2013-14, the Urban Malaria Scheme is currently being implemented in 131 towns of 19 States and Union Territories covering 130 million people but is it enough?

Controversy over Malaria data

A 2010 Lancet study stated that more than 2 lakh Indians die of malaria every year. This generated a lot of controversy as the National Vector Borne Disease Control Programme had reported only 9,778 deaths due to malaria in the last decade. The same study also found that 90% of deaths occurred in rural areas, of which 86% occurred at home without any medical attention. According to the World Malaria Report 2014, 22% (275.5m) of India's population live in high transmission (> 1 case per 1,000 population) areas. In 2013, Maharashtra and Odisha reported the highest number of deaths due to malaria but the highest number of registered malaria cases were reported in Odisha (2 lakh) followed by Chhattisgarh (1 lakh) and Jharkhand (97,215) cases.


Climate change is expected to alter the spread of malaria in the country. A study published in the Indian Journal of Medical Research says that the geographic range of malaria vectors will shift away from central regions toward southwestern and northern States by the 2050s. The duration of exposure is likely to widen in north and west India, and shorten in south India.

Link with canals and dams

Research shows that irrigation canals have increased malaria risks. Around 10.9 million people are at risk of malaria due to large dam sites and irrigation canals in India. The Thar desert in Rajasthan was hit by its first major malaria epidemic in 1990 recording 48 deaths. This was followed by a bigger disaster in 1994 with double the calamities when the Indira Gandhi Nahar Pariyojana was extended causing seepage and water-logging due to faulty design. Around 100 cases of malaria in Jaisalmer district were reported in May 2012.

After the implementation of the Mahi-Kadana project in India, the annual parasite index in just 15 years of its implementation increased from 0.01 to 37.9. In Meerut and Gurgaon, the incidence in canal-irrigated villages increased up to nine-fold.

Increasing Economic Burden

According to a study, the economic burden of malaria in India is $1940 million with 75% of the burden coming from lost earnings while 24% comes from treatment costs. The Indian government spent $99.52 million in 2011 for the malaria control programme, which dropped to $51.33 million in 2013. It isn't surprising that prevention measures are far from desirable standards.

Mosquito nets treated with insecticide and indoor spraying are two globally-accepted measures to protect the high-risk population. In 2013, India provided this protection to less than 20% of the vulnerables leaving a huge segment uncovered.


Under the National Health Mission, Community Health Workers (ASHA) were provided with drug kits in which medicines related to malaria were also supplied. The Empowered Procurement Wing has procured anti-malarial drugs of Rs 146 crore but due to long government systemic processes, the drugs do not reach the community health workers on time especially in remote villages.

“In the last three years, the government malarial drug supply has not improved much. The availability of drugs to the community health workers needs to be regularized”, says Pooran Singh, Regional Coordinator Bastar division, State Health Resource Centre, Chhattisgarh.

Malarial eradication needs a fresh approach. The dependence on a large chunk of international funding alone is not a sustainable solution to control and eliminate malaria in India.

This article was originally published on India Water Portal.

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Removing the layers of complexity that weigh down mental health in rural India

Patients in rural areas of the country face several obstacles to get to treatment.

Two individuals, with sombre faces, are immersed in conversation in a sunlit classroom. This image is the theme across WHO’s 2017 campaign ‘Depression: let’s talk’ that aims to encourage people suffering from depression or anxiety to seek help and get assistance. The fact that depression is the theme of World Health Day 2017 indicates the growing global awareness of mental health. This intensification of the discourse on mental health unfortunately coincides with the global rise in mental illness. According to the latest estimates from WHO, more than 300 million people across the globe are suffering from depression, an increase of 18% between 2005 and 2015.

In India, the National Mental Health Survey of India, 2015-16, conducted by the National Institute of Mental Health and Neurosciences (NIMHANS) revealed the prevalence of mental disorders in 13.7% of the surveyed population. The survey also highlighted that common mental disorders including depression, anxiety disorders and substance use disorders affect nearly 10% of the population, with 1 in 20 people in India suffering from depression. Perhaps the most crucial finding from this survey is the disclosure of a huge treatment gap that remains very high in our country and even worse in rural areas.

According to the National Mental Health Programme, basic psychiatric care is mandated to be provided in every primary health centre – the state run rural healthcare clinics that are the most basic units of India’s public health system. The government provides basic training for all primary health centre doctors, and pays for psychiatric medication to be stocked and available to patients. Despite this mandate, the implementation of mental health services in rural parts of the country continues to be riddled with difficulties:

Attitudinal barriers

In some rural parts of the country, a heavy social stigma exists against mental illness – this has been documented in many studies including the NIMHANS study mentioned earlier. Mental illness is considered to be the “possession of an evil spirit in an individual”. To rid the individual of this evil spirit, patients or family members rely on traditional healers or religious practitioners. Lack of awareness on mental disorders has led to further strengthening of this stigma. Most families refuse to acknowledge the presence of a mental disorder to save themselves from the discrimination in the community.

Lack of healthcare services

The average national deficit of trained psychiatrists in India is estimated to be 77% (0.2 psychiatrists per 1,00,000 population) – this shows the scale of the problem across rural and urban India. The absence of mental healthcare infrastructure compounds the public health problem as many individuals living with mental disorders remain untreated.

Economic burden

The scarcity of healthcare services also means that poor families have to travel great distances to get good mental healthcare. They are often unable to afford the cost of transportation to medical centres that provide treatment.

After focussed efforts towards awareness building on mental health in India, The Live Love Laugh Foundation (TLLLF), founded by Deepika Padukone, is steering its cause towards understanding mental health of rural India. TLLLF has joined forces with The Association of People with Disability (APD), a non-governmental organisation working in the field of disability for the last 57 years to work towards ensuring quality treatment for the rural population living with mental disorders.

APD’s intervention strategy starts with surveys to identify individuals suffering from mental illnesses. The identified individuals and families are then directed to the local Primary Healthcare Centres. In the background, APD capacity building programs work simultaneously to create awareness about mental illnesses amongst community workers (ASHA workers, Village Rehabilitation Workers and General Physicians) in the area. The whole complex process involves creating the social acceptance of mental health conditions and motivating them to approach healthcare specialists.

Participants of the program.
Participants of the program.

When mental health patients are finally free of social barriers and seeking help, APD also mobilises its network to make treatments accessible and affordable. The organisation coordinates psychiatrists’ visits to camps and local healthcare centres and ensures that the necessary medicines are well stocked and free medicines are available to the patients.

We spent a lot of money for treatment and travel. We visited Shivamogha Manasa and Dharwad Hospital for getting treatment. We were not able to continue the treatment for long as we are poor. We suffered economic burden because of the long- distance travel required for the treatment. Now we are getting quality psychiatric service near our village. We are getting free medication in taluk and Primary Healthcare Centres resulting in less economic stress.

— A parent's experience at an APD treatment camp.

In the two years TLLLF has partnered with APD, 892 and individuals with mental health concerns have been treated in the districts of Kolar, Davangere, Chikkaballapur and Bijapur in Karnataka. Over 4620 students participated in awareness building sessions. TLLLF and APD have also secured the participation of 810 community health workers including ASHA workers in the mental health awareness projects - a crucial victory as these workers play an important role in spreading awareness about health. Post treatment, 155 patients have resumed their previous occupations.

To mark World Mental Health Day, 2017, a team from TLLLF lead by Deepika Padukone visited program participants in the Davengere district.

Sessions on World Mental Health Day, 2017.
Sessions on World Mental Health Day, 2017.

In the face of a mental health crisis, it is essential to overcome the treatment gap present across the country, rural and urban. While awareness campaigns attempt to destigmatise mental disorders, policymakers need to make treatment accessible and cost effective. Until then, organisations like TLLLF and APD are doing what they can to create an environment that acknowledges and supports people who live with mental disorders. To know more, see here.

This article was produced by the Scroll marketing team on behalf of The Live Love Laugh Foundation and not by the Scroll editorial team.