© 2007 Institute of Current World Affairs
The Institute awards long-term fellowships to develop a deep understanding of an issue, country, or region outside the US and to share that understanding with a wider public.
Institute of Current World Affairs - Home Page

Below is a hobbled text version of a PDF document.
In order to read the actual document please click the link below and register if necessary.
(One-time registration is free and very quick.)
Read article

6/6/1964 - India: Success Story by Granville S. Austin

NOT FOR PUBLICATION INSTITUTE OF CURRENT WORLD AFFAIRS A Ni amuddin Wes GSA New Delhi India Success June Mr Richard H Nolte Executive Director Institute Current World Affairs Madison Avenue New York New York Dear Dick India about problem years I because years study effort Because I0 years timely American because created magnificently functioning organization The existence organization perhaps eworthy accomplished compleed oherso The Atharva Veda written about B C described fever classified according attacks daily alter every third It called fever King Diseases associated insects whose appearance habits described So India awareness malaria itself enter English language until 1820zs association mosquitos Six yearn Government India after years experimentation search programs control malaria launched National Malaria Eradi cation Program N M EoPo In years program completed Zancien curse India wiped This achievement especially fiing because major discoveries malaria research including vital discoverY which other investigation stemmed malaria transmitted mosquitos Sir Ronald Ross British doctor proved But there earlier discoveries T E Demps member British commission Punjab employed first spleen index incidence technique continues valuable measure estimating incidence disease according presen director N M E P Sir Rickard Christuphers first malaria research organization India first person determine really severe malaria affects population Chrisophers Singhbum district Benal Bihar border Lt Colonel J A Sinton director Malaria Survey India successor Christophers Central Malaria Bureau which founded pioneered studies overall effect malaria population disease country Lt Colonel Jaswant Singh after World War II director Malaria Institute India Survey discovered useful stain revealing malaria parasites human blood That malaria research institutions headed military surprisin realizes soldiers hospitalized India before fifth incapacied malaria despie relatively higher proecion military received relation civilian population mosquito control barracks canon areass Bu malaria plagued military devastating civilian population On economic social humanitarian groundss magnitude malaria problem warranted research possible efforts control India million quarter square miles population millions Ninety malarious eradication program began population suffered varying degrees disease This ulation United Staes living U S suffered communicable disease This Indiats malaria problem Thirties total population millions million persons suffered annually malaria Taking agricultural small population although percentage certainly higher influ cities sared present figure population living person countryside disease A million deaths directly caused malarias estimateds epidemic years another quarter million Another million deaths annually tributed indirectly malaria because fever weakened sufferers became preyo ailments Sinton monograph Ma commented serious effects malaria rived The disease marked effect nervous system taliy individuals afflicted wrote I easyo childs whose early years marked succession weakening atacks fevers probably enter debilitated consti tution educated And adulss Sinton The lassitude caused disease tends become fimed later talaria perpetuates ignorance ignor malariaJ Sinon investigated malaria country production agricultural industrial wages earned He estimated economic India directly malaria least million rupees yearly Considering families nation indirec effects decided billion rupees It probable amounmaybewicethissumatleasp Sinonaddedsand heconcluded As malaria preeminently rural diseases agriculture chief support countrys which industry India sustains enormous The influence disease agriculture therefore ofhemo imP0rtan economic problems India In recent years experiments surveys borne Sintonts views An enquiry MSore state based families showed malaria control eradicati0n increased earning power thousandrupees return money spent control ratio ofi93 In Punjab districts alone malaria measures allowed increase oduction worth million rupees according senior malariologist Health Organization Malariologists working eradication program visits villages wheres height harvest seasons entire adult ulation unable because fever villages where babies lived through their first yearo The importance malaria having appreciated measures taken against Anti malaria campaign began early century followed directly Ross proof mosquitos carried disease These efforts consisted attacks On mosquito larvae spraying chemicals Paris green breeding areas Although local scope technique successful holding incidence malaria By Thirties yrethrum sprays developed directly against mosquitos Bu pyrethrum commercial sprays Flit expensive nation campaign could successful point The habits quitos rendered inefficient lethal capacity quickly dissipated For military urban pyrethrum sprays reasonably effective The great break through malaria development DDT during exact DDT dichlor diphenyl trichlorethane residual spray makes ifference When mixed solution water producing suspension sprayed surfaces walls ceilings house mosquitos months happily malaria carryin mosquitos susceptible DDT other arieties The harder surface overlaid after spraying dusty smoke smudge longe lasting killing power Because their habits their susceptibility property DDT makes especially effective against malaria carrying mosquitos Malaria carried anopheline species mosquito There kinds anophelines India malaria carriers vectors trade prime importance These types carriers ferent habits breeding sluggishly moving water light shade streams sandy banks verges grass vegetation ricefields reservoirs Anophelines breed drains filthy stagnant mosquitos despite variaions habits They blood animal human8 customari1 harbour partic ularly after feeding dwellin plaes animals Now malaria transmitted An anopheline person infected malaria gorges belly contened flies nearest ceiling During malaria sites develop sufficiently mosquito reach salivary glands disease Should infected mosquito alight sprayed DDT however absorb enough spraying Thus chain transmission broken Depending strength DDT remaining mosquito several hours after periods resting If first exposure mosquito again before infectious After feedizg second returns receives second exposure DDT Again chain transmission broken Hence DDT property residual effect makes sible malaria control eradication chain transmission broken malarial infections place there reinfections Yet there still reservoir parasites already infected humans Does spraying prevent transmission therefore forever The answer Three thins happen individual malaria He If longer source disease He ciparum malaria attack fever But detected would under eradication program cured drugs He vivax which dormant Undetected reinfected disease within naturally three years Thus spraying dwellings buildings three years transmission prevented reservoir malaria passage vigilant surveillance destroyed Then doesn difference except human comfort mosquitos there there disease anopheline carry This logic first malaria control extension malaria eradication Some knowledge Indian malariologists instance malaria parasites three years enough D1 T available could think terms local malaria In Government India Health Survey National Development Committee recommended estab lishment nation malaria organization Various provincial governments Federal Government experimented DDT malaria control during great success In newly established Planning Commission recommended India malaria program given priority United States World Health Organization U N I C E F Rockefeller Foundation joined forces government The produced called malaria control units covering about million population worst malaria areas In December Governments India United States signed agreement bringing existence National Malaria Control Program The Americans provide DDT spraying equipmeht transport funds The Federal Government provide malaria research training programs direction would channel American The states India assume field operations The control malaria bring transmission level which would cease major health problem The program success It extended units covering million persons incidence malaria control areas dropped sharply At beginning program Andhra state example children infected parasites whereas children malaria In Bihar centare dropped Madhya Pradesh dropp 0rissa These percentages Were determined spleen A number diseases cause enlargemen spleen malaria By measuring spleens abnormality endemicity malaria determined The proportion malaria cases other diseases areas under control program equal sharpness During years control program India events place parts world altered India goals It covered areas subjected DDT spraying years persons malaria parasites their blood The Venezuelan 6overnment folling stopped spraying malaria appear Also discovered early Greece types anophelines becoming resistant I DT Malariologists decided solution massive spraying three period lower intensity spraying period parasite reservoir eliminated before DDT resistance developed mosquitos Resolutions these developments WHO resolved reques governments intensify malaria control programs eradication A regional committee session WHO Delhi adopted eradi cation countries The prospects these programs improved greatly stimulated missions abroad Uo Congress began appropriating funds under futual Security Program directly countries around world malaria eradication programs Previously funds channeled through World Health Organization international India National ialaria Eradication Program effect April signing another agreemen between United States 6overnment India As before American contribution partly funds partly DDT transport No spraying equipmen needed because India produced compression sprayers spray string beans stirrup pumps A large amount credi sufficiency Fred W Knipe Rockefeller Foundation helped production these pumps WHO contributed funds purchase insecticides Eradication achieved system centralized direction decentralized execution according directoro The country divided units covering million persons where possible units folloed boundaries basic local administration sates India I tables organization understand eradication carried At Director NoM E P since Dr A P Ray likeable dynamic Under director regional ffices deputy director assistan deputy directors Into regions grouped states India Dr Ray describes offices acles liason between states director The authority Federal Government echnically stops regional offices Responsible N M EP state official called state malariolois acting director public health service himself senior member service The states divided varyin number zones under zonal officers supervise three eight units about million population which divided It level field operations really begin Units headed officers often called malaria officers usually physicians The assistant malaria officer staff The units divided units usually headed senior malaria nspector assisted junior malaria officer In units eradication split spraying surveillance activities On spraying senior malaria inspector called superior field workers leads spray These teams organized pumps The number spraymen varies depending difficulty spraying operation whether instance villages close together apart state roads paths hilliness terrain whether jungle The these spray twice yearly million dwellings Spraying normally takes place June November Houses sprayed before transmission season again several weeks after begun In areas incidence round transmission houses sprayed three times Spraymen seasonal labour except superior field rkers cruited through state labour exchanges They tended return season after season however spraying undertaken green hands important factor I spray requires expertise The these rupees monthly under scales varying state state Not money welcome addition family poverty stricken country The surveillance organized Under senior malaria inspector usually malaria surveillance spectors supervises surveillance workers alaria veillance inspectors surveillance workers recruited adver tisments newspapers public notices senior malaria spectors upwards officers merit appointments state public service commissions Senior alaria inspectors training alaria Institute India Delhi least years experience malaria university science degrees Surveillance spectors usually reached matriculation standard effect school graduates surveillance worIers meagre training The surveillance worker visit every house about persons everytwo weeks record visit He enquires there anyone fever household If takes blood smear person affected gives drugs sumptive malaria The worker reports superior Should smear parasites several things happen The person receives radical malaria treatment All drugs cases malaria treated vately doctors private physician government blood smear patient smears taken surroundiing families teams respray surrounding houses authorities source infection Was relapse latter person exposed Was stranger village carri person GSA neighbouring The malaria surveillance inspector charged visiting every village sector month workers doing their As villages accesible bicycle paths malaria eradication program demands great amount walking The price malaria eradication liberty eternal vigilance Dr exists bottom organization He calls concurren consecutive supervision meaning manls moment checked supposedly before A senior malaria inspector example usually accom panied several superiors inspects spraying Under their excellent He finds where sprayed before village He women houses spray Yes Did spray house Yes Please He finds because DDT crystals walls spraying slipshod If failure expertise superior field worker reprimand docked month spray training laxness superior field worIer fired Or senior malaria inspector finds house sprayed woman house thought enough Again superior field worker trouble officer perhaps Ray himsel along explain woman adults contract malaria probably infected This usually effect Or officer Daughter I getable garden I going fence three sides And fourth To which replies Do never sprayed Do children never The woman usually spray whole house Surveillance workers checked officers going village finding about fevers If villagers worker fired immediately If answer question Did No Has other village month check fevers If answer surveillance inspector fired immediately Surveillance workers supposed record standardized chart their visits house village hamlet house India numbered purpose record blood smears taken An investigating officer smear cards example house which smear allegedly If family reports smear taken blood probably surveillance worker fired laxness The hiring firing malaria surveillance inspectors surveillance workers superior field workers zonal level retribution swift These methods sound somewhat brutal arbitrary unpleasant evidently All those involvedwith I spoken agree levets especially there little sense responsibility threat ensures attention This rigorous vigilance system continues higher levels Senior malaria inspectors heads units often shifted another period officer another given their To protect themselves gives closest scrutiny efficiency They others throats Ray There shielding result amount sacking tremendous In areas turnover years ohers The result Rays about urnover As malaria officers upwards their Ray regional officers state malariologists zonal officers constantly checking finding fault repairing Ray insists every officer spend least nights month field This cause private lives If officer higher level doing informs Ray doesn malaria eradication Ray another another organ ization But stays doesn improve He fired disgrace Ray Keeping N E P running smoothly involves dealing called federal issues Despite centralized charact Indian federalism state governments spheres great autonomy public health In Indian Constitution legislative lists competency state legislatures Union Parliament regard possible subjects And State List Public health Sanitation hospitals dispensaries On Union List there entry concerning health Constituent Assembly efforts members federal government public health Union concurrent subject either states Parliament could legislated firmly rejected states But Concurrent List entry Economic Social Planning Through loophole Union Government direct national malaria eradication program Because states autonomy matter public health however direction exercised Ray weapons diplomat negotiation cajolery At inception eradication program ponsored aided financially materiel Union Government DDT transport course U S The Union provided technical direction supervision evaluation program After initial stages passed however Union discontinued sorship program planned three conversations between Union Planning Commission Ray N E P headquarters state governments Planning responsibility transferred states while overall direction continues Union Ray Yet Ray clear directors public health states charge their programs This presumably beneficial psychological effect Ray position where could extreme occasions bluntly This program things going Either prove I withdraw support This approach Ray effect health director chief minister state inclined resist officials neighbouring states cooperating Ray would pressure recalcitrant official order protect their eradication programs Ray evidently found threat withdrawing support tangible intangible lever sufficient early Now technique largely replaced positive methods The first these bringing state malariologists I0 other officers states Delhi trainin orientation Malaria Institute although cases officers already alumni Institute The second technique direct participation state public health directors program national level gainin their support involving while gaining their indoctrinating This seems Ray successful innovation In Ray instituted system yearly review entire N P effort Independen Appraisal Teams This exnple there teams appraisal which place February Each headed director state public health members One member defence forces Union Health Mintry organization member malaria expert World Health 0rganization U S other outside organization Each spent weeks field assigned checking eradication program No health director appraised program state The reports checked three consultants given teams orientation briefing before appraisal began passed Ray This consultants Director National Institute Conmunicable Di seases Delhi Southeast Asia malaria consultant WH0 malarioloist U S missioa As result system state health directors radiction program Ray cooeration Ray himself provided reports improve organization Let return progress eradication program The program began April establish units coverin million persons malarious areas country One hundred forty units already under alaria control program These expanded scale units would attack phase operation scale spraying dwellings curative measures against malaria cases discovered The surveillance operation parallel spraying existence became stabilized By close ttack phase completed units entered consolidation phase which there spraying surveillance activity continued By another units changed attack consolidation The position units coverin million persons eradi cation program completed units entered maintenance phase which watch against recurrences malaria handed general health services state Two hundred eight units entered consolidation stage incidence malaria In units attack phase surveillance going concur rently Of these units3 scheduled consolidation phase judged ready independent appraisal system The units attack phase after likely remain Ten units cover extraordinarily difficult terrain other areas bordering Burma Pakistan Nepal Generally speaking these three countries reached India level malaria India therefore maintaining cordon sanitaire protection iPaistan making rapid strides toward malaria control however program border areas helping India considerably The units Burma border western parts border Nepal Ray expects spraying Throughout decade malaria control eradication programs there contrary I expected little resis tance villagers For reason necessary ccompany programs large educational propaganda campaigns educa tional vould effect ofthose involved believe Ray health education process could afford Efforts education indoctrination taken place usually difficulties encountered An early stumbling block subsequent neither frequent spread villagers belief malri orkers revenue officials This dangerous misapprehension easily dispelled In several cases villagers believing presence strngers contaminated their houses wanted replaster Which course rendered spraying useless Explanations importance spraying overcame difficulty Some families prevented spraymen lower caste themselves entering their houses again ficulty overcome persuasion Somewhat important resis tance spraying after several years The villagers tired suspicious intrusions understand tinue Also beginning malaria control authorities talked terms mosquito eradication When place villagers began think mislead No slogan eradication program painted villagells We mosquitos malaria The United States began contributing malaria India agreement signed beginning control program It continued funds materiel through From current onward UoSo loans grants Of total malaria programs approximately million United States contributed millionin DIE equip million funds joint rupees derived wheat sales under PL The United States contributed services malariologists One these Dr Raymond Laird India years malaria Indonesia years before coming Dr Laird became malariologist seconded missions US Public Health Se since Burma first abroad The success malaria control eradication programs nothing short stupendous statistical human terms Babies feral region United Provinces example malaria before Adults instead being trated fever harvest their wheat The nearly million yearly cases estimated malaria India dropped control became eradication figure fallen cases At ginning control program malaria believed constitute nearly sickness India At amounted This success great measure dedication personality Dr A P Ray It scheme ganization When I first Ray office dressed sandals white rousers smoothly starched khaki shirt throat He biggish Indiaand movements quick definite Hhile talked smoked cigarettes played match In country where standard English spoken command language stands He about years Before spent National Institutes Health Bethesda iaryland working micro biology formal education research India He recieved BSc PhD Patna University Bihar During United States Ray worked briefly Harvard Com municable Disease Center Atlanta Georgia spent enrout London School Tropical Medicine Ray entered field malaria studies later continued Indian Iraq other Arab countries Mountbatten Southeast Asia command We activity malaria control Ray laboratory field before concept eradi cation accepted The National alaria Eradication Program Ray directs descendent former alaria Institute India The Kalaria Institute itself expanded become July National Institute Conunicable Diseases lithin Institutes Rayts NM E P autonomous status Ray ranks director Institute kindly rotmd faced grizzled named Dr S P Ramakrishnan Ramakrishnan regrets Ray departure laboratory He scientist I think because great executive ability With malaria eradication program drawing close happen organization success Ray appears believe fused network primary health centers being developed countryside These health centers treat persons watch recurrences malaria other communicable diseases undertake environmental family planning campaigns against specific diseases smallpox Other individuals I talked confident They would prefer organization remain intact given family planning instance One thing certain truly crime organimation personnel allowed waste But happens subject future newsletter Yours sincerely Granvi11e Austin Received New York June