New Delhi, Oct. 28: India’s malaria hotspots appear to overlap with Maoist strongholds, public health experts said today, listing local development and improved governance among actions that could help reduce illness and deaths from the infection.

Malaria is rampant in parts of Andhra Pradesh, Chhattisgarh, Jharkhand, and Orissa where lack of development and poor administration has prevented the emergence of reliable healthcare services, the experts said at a consultation on public health.

“We look at the map and we see malaria is now localised in about 70 districts — but most of them are trouble districts,” said Jayaprakash Muliyil, professor of community health at the Christian Medical College, Vellore.

“They’re tribal areas, forest areas, places where the health systems aren’t working, places where there is unrest,” Muliyil told The Telegraph, on the sidelines of the consultation organised by the Public Health Foundation of India.

Infectious disease experts believe the health ministry’s figures of 1.7 million malaria cases and 1,707 deaths — during 2006 — are gross underestimates. Using independent estimates, they believe up to 10 million people were infected and more than 15,000 died from malaria that year. “We’re not getting the true picture,” said Garima Pathak, assistant professor at the Indian Institute of Public Health, New Delhi.

The panel of experts who met for the two-day consultation have penciled a set of recommendations for the government to address barriers to malaria management: policy and administration issues, human resources, and drugs and diagnostics.

“There are no easy solutions — malaria is sensitive to the political climate,” Muliyil said. “It has social dimensions — development, improved local administration, and local leadership will help malaria control.”

The experts said poor development and the absence of local infrastructure in endemic areas are contributing to malaria deaths. “When a road is in bad shape, how is a patient with severe symptoms to be ferried fast to a tertiary health facility?” Pathak said.

“Many actions would have to come from outside the health sector — but aimed at making health systems more efficient and responsive to needs of local communities, said K. Srinath Reddy, president of the Public Health Foundation of India.

The panel also said an “ownership barrier” is hampering effective malaria control. “This is a central (government) programme — but we need community participation through local ownership,” Pathak said.

“We need local communities to participate in malaria control actions,” she said.

The consultation has recommended deployment of additional health staff in malaria endemic zones, improved surveillance that takes into account information from both the public and private medical sector, and mechanisms to ensure that quality drugs and diagnostic kits are made available in malaria-affected zones.

Such steps, said Muliyil, would have to run in parallel with standard control strategies such as the use of sprays and mosquito nets, personal protection through appropriate clothes, environmental management.