Times of India
22 September 2010
As the world reviews progress on the Millennium Development Goals (MDG), Jai P Narain, director, communicable diseases, World Health Organisation, regional office for South East Asia, argues that the South East Asian region is "on track" in achieving MDG 6. Narain spoke to Aditi Bishnoi:
HIV/AIDS, malaria and tuberculosis, the focus of MDG 6, remain a major source of concern in South East Asia. Any progress?
The region is on track in terms of achieving MDG 6. Of course, given the diversity between and within countries, it could be considered uneven. Overall, though, it has been good. For example, take TB. All the countries have expanded DOTS and nationwide coverage has been achieved. As a result, we see a reduction in the risk of infection and TB–related mortality.
India, Indonesia, Myanmar, Nepal and Bangladesh are some of the countries spearheading this progress. HIV prevalence is declining in a number of countries in the region. On malaria, while there has been some progress, we need to do a lot more in ensuring accelerated scale–up of bed net distribution and in adopting new treatments that not only cure malaria but also help limit its spread.
Some population groups have reportedly developed resistance to TB drugs.
Drug resistance is a major concern. In the context of TB, it renders treatment more difficult, more expensive and a challenge to cure. Drug resistance is a global phenomenon. It can occur naturally, but more often because of the irrational use of medicines. Some important strategies to combat it include the rational prescribing of medicines by doctors and healthcare workers and the appropriate use of drugs by the patients themselves. Regulation also has an important role to play. For example, the sale of scheduled drugs over the counter contributes to this situation.
What are the general principles to keep in mind while addressing communicable diseases in the region?
First, a complete understanding of the disease and its determinants. Without good understanding of the disease distribution and risk factors, we can neither plan properly, nor set realistic targets. Second, partnerships and collaborations are essential. Health is not the responsibility only of health ministries; it has to become everyone’s responsibility. Third, improving health system capacity to be able to deliver on health promotion and disease prevention. Finally, ensuring equity and providing good quality and affordable health services particularly to those who need it the most.
Child and maternal mortality – MDG 4 and MDG 5 – remain a major concern in the region.
Yes, of course! While there has been progress over the past few years, it is neither substantial nor fast enough, especially in MDG 5. There are also great social disparities to contend with – most of the deaths among children below five years occur in the poorest populations. It is tragic that in spite of simple and costeffective interventions available today, more than 1.3 million children below five years of age die in this region of pneumonia and diarrhoea. There are many factors responsible for this, including poverty, under–nutrition, poor sanitation and personal hygiene and, of course, lack of access to health services, information and safe water. Clearly, this is a multifactorial problem that needs a comprehensive and broad inter–sectoral approach.
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