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Sister company of Health Issues India evaluates EU investments in Indian health

A new study reports that it is difficult to show the overall impact of massive European investment in poverty-related diseases. The study was conducted by RAND and Baird’s CMC, a policy research company that is in the same group of companies as Health Issues India. The study, commissioned by the European Union (EU), did report examples of major positive impact.

Poverty-related and neglected diseases (PRNDs) cause death and disease across the developing world. Some of the most common diseases within this category are malaria, HIV and tuberculosis (TB). These diseases are endemic in India which also faces considerable issues with a host of other lesser known diseases such as leishmaniasis and leprosy.

India’s malaria surveillance system was recently ranked among the worst in the world by the World Health Organization (WHO). India also faces considerable issues with tuberculosis (TB), with a rising number of cases of drug resistant TB.

The study came from RAND Europe and Technopolis Group, with support from Baird’s CMC and Institut de Recherche en Sciences de la Santé (IRSS). It assessed the impact of EU funding and whether it has played a role in lessening the burden of these diseases within developing nations and LMICs.

The study encompassed a literature and data review which covered EU data on funding allocation and project details. Baird’s CMC conducted and analysed interviews with multiple stakeholders  in India and in Tanzania, South Africa, Burkina Faso, Brazil and Thailand.

The diseases the EU funding focuses on are commonplace within India, but to what extent has the funding contributed to reducing disease prevalence within the country?


HIV/AIDS, tuberculosis and malaria: the primary targets of EU funding


The study found that EU investment of €1.445 billion benefited a total of 930 PRND projects. Of these, 64 percent were focused on HIV/AIDS, TB and malaria.

Despite advances, these three diseases continue to be significant public health concerns in India and are prevalent throughout  the world. The WHO ereports that 36.7 million people living with HIV at the end of 2016, with 1.8 million people becoming newly infected across the course of the year. HIV is most common in African nations, which often lack the financial resources to adequately address it without external aid.

In 2016, the WHO recorded 10.4 million cases of TB, with 1.7 million resultant deaths (including 0.4 million among people with HIV). Over 95 percent of TB deaths occur in low to middle income countries (LMICs). India has the highest number of cases of TB: it and six other nations account for 64 percent of all cases.

Malaria, though causing fewer deaths than TB and HIV, has a far higher number of cases. There were an estimated 216 million cases of malaria in 2016, with the bulk of these cases occurring in poorer nations across Africa and Southeast Asia. Africa accounts for around ninety percent of malaria cases. Outside of sub-Saharan Africa, India has the highest burden of malaria cases.


Positive case studies


GeneXpert is an example of one of the products of EU research, according to the report. It is a molecular detection tool which analyses for hallmark DNA samples from the TB bacteria. The test was developed in part with funding from the EU. The test is widely used in India under the product name CB-NAAT. The test is incredibly fast, taking only 2 hours. This is a vast improvement on techniques such as sputum microscopy, which may take several weeks to produce a result. GeneXpert also has the advantage of detecting genetic mutations associated with resistance to the drug rifampicin.

EU funding has also contributed to the creation of Pyramax a fixed-dose combination of pyronaridine and artesunate for the treatment of malaria. The producers of this combination treatment have focused on the education of those receiving treatment in its correct usage, promoting adherence to the treatment to ensure effective outcomes.

The HIVIND project is another example of collaborative work between the EU and, in this case the Institution for Population Health and Clinical Research, India. The project assessed the adherence to first line antiretroviral treatments for HIV within India. It reported  that there was a lack of affordable second line treatments in India. Due to this, adherence to first line therapy is essential.


Gaps in the system limiting impact?


While the development of new medications or diagnosis techniques is  a quantifiable means of measuring the impact of an investment, it is far more difficult to gauge the impact of financed projects where there is no technological development.

Numerous challenges exist which limit the ability to study the real world outcome of such investments. Funding was not allocated uniformly, and many projects were targeting far less media-friendly conditions such as leishmaniasis or leprosy.

India has a clear issue with the implementation of projects regarding disease elimination. The National Health Budget 2017 set out a number of deadlines for diseases featured within the EU investment portfolio such as leprosy and leishmaniasis (kala-azar). The most recent deadline to have been missed was that of kala-azar, which was set to have been eliminated by the end of 2017.

Sporadic outbreaks of kala-azar were found to still occur across numerous states within India, as such the disease could not be considered eliminated. Blame was placed on inconsistent surveillance of outbreaks, allowing for resurgence of the disease in many locations. If EU funding were to occur in this disease area, its effects may be limited due to lacking infrastructure and surveillance programmes.

Funding towards the creation of new medicines or medical devices may not directly benefit a vast number of people in the  LMICs which were included in the RAND, Baird’s CMC study. The GeneXpert TB diagnosis tool, for example, is used in India and South Africa but is unlikely to be used in remote rural locations across the rest of Africa. Other countries involved in the study, such as Burkina Faso and Tanzania, will not receive similar benefits from this investment. This limitation has a direct impact on the outcomes and reduces the effect that the initial investment has had on TB prevalence.


RAND’s suggestions


The report suggests a shift in focus from the funding of initial research to its implementation within the target nations. The use of grassroots campaigns within rural locations, for example, may produce more tangible results with a measurable impact on disease prevalence in the target areas than would funding of research

In India, investments into healthcare infrastructure could go a long way to improving the country’s healthcare system. Vaccination drives could also significantly reduce disease prevalence. A focus on developing connections between the government and suppliers of medicines could also allow for increased access to affordable healthcare.


India’s own failings


In many cases, the impact of the EU funded projects is limited by the healthcare infrastructure of the target countries. India is a key example of this. Shortages of medical staff are commonplace, especially in rural environments. Some areas have reported up to 81 percent fewer specialist medical staff than is required for the population in the area.

Shocking figures such as the fifty infectious disease specialists catering to the entirety of India are commonly reported on Health Issues India. Without boots on the ground there is no way to make any advancements available to those affected by disease.


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