Polio eradication
The first reported case of a deadly polio strain in a girl from a Delhi slum underscores how the challenge of health has become similar to a war in more ways than one. The public policy response needed is much more complex than that to the danger posed by an outbreak of bird flu in the country's poultry population. The polio problem requires an ongoing effort that cannot be divorced from the state of health delivery in the country. The virus has escaped eradication in those states which have some of the worst health indicators, rickety delivery systems and huge numbers of the desperately poor who form the bulk of the country's job migrants. It is hard for the health administration to track a poor and mobile population with a high likelihood of being carriers of communicable diseases like polio. Until now, the government machinery in the states or at the Centre has shown precious little awareness of this facet of the problem. True, the Union Budget for 2008-09 has allocated as much as Rs 1,042 crore to the cause of polio eradication. The finance ministry has not been stingy. Saving the tiger has got only a fraction of that sum. But will the money be used effectively? The polio problem offers a striking parallel with the Naxalite menace in large parts of India. Just as the police posts charged with the task of law-and-order across hundreds of sq km of Indian forests have little idea where the next militia attack will come from, the country's sad-looking primary medical centres have very little knowledge of how polio is spreading among population groups in geographical areas left unmonitored. It is a very large country. Despite heavier spending and more national taskforces, efforts to tackle polio would have limited success unless the entire health delivery system is padded up in the country, just as policing methods have been spruced up for new challenges. The difficulty here is not the funds, but the lack of any clear political dividend from the adoption of such steps. More jobs mean more votes, but what about better health? Also, health problems require active cooperation from the afflicted population groups, and thus outreach plans and persuasion methods are important. So long as nobody seems to have a direct stake in the success of these efforts, their quality will remain indifferent.
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