Lymphatic Filariasis: Budget boost essential to combat disease escalation in India

Lymphatic Filariasis brings a staggering estimated annual economic cost of $1 billion to India.

By Dr. Neeraj Dhingra

In the subtropical and tropical regions of India, a relentless mosquito-borne disease - Lymphatic Filariasis (LF) continues to impact millions of lives. This disease is caused by filarial parasites transmitted through mosquito bites, leading to a physically debilitating condition. However, the discomfort and disease manifests in number of ways. 

Physical manifestations include acute cases of local inflammation of the skin, lymph nodes, and lymphatic vessels and the chronic conditions include lymphoedema leading to elephantiasis (swelling of limbs), and hydrocele (scrotal swelling), which can lead to physical disability. However, the emotional, social, and economic burdens transcend the physical ones. Lymphatic Filariasis brings a staggering estimated annual economic cost of $1 billion to India and imposes a global financial burden of at least $5.8 billion each year. What follows is a vicious cycle of deepening financial and emotional distress, further worsened by social stigma culminating in a loss of jobs and a lack of healthy workforce in already struggling and resource-scarce communities.  

We take a closer look at how India and its endemic states are tackling these economic challenges with focused inclusivity and targeted efforts for LF Elimination by 2027. 

India’s Efforts for Early Elimination of the Disease  

India’s commitment to eliminating lymphatic filariasis by 2027, ahead of global deadlines, reflects the priority the disease receives due to its onerous impact. The country had earlier adopted a dual strategy: Mass Drug Administration (MDA) to halt new infections and Morbidity Management and Disability Prevention (MMDP) to support those already affected. 

MDA involves annual free-of-cost distribution of DEC (Diethylcarbamazine) and Albendazole for at least five years in endemic areas to interrupt disease transmission. To fast-track these efforts, the government has adopted a new tool, IDA – a Triple drug regimen in which a dose of three anti-filarial drugs is administered (Ivermectin, DEC, and Albendazole- IDA). On the other hand, MMDP advocates for the inclusive approach of providing cost-efficient home-based care for lymphoedema with free-of-cost hydrocele surgeries at all government medical facilities.  

In 2023, a revised five-pronged strategy was adopted, which includes i) Mass Drug Administration campaigns, ii) early diagnosis and treatment, iii) integrated vector control, iv) inter-sectoral convergence, and v) leveraging existing digital platforms and innovations in lymphatic filariasis diagnostics to achieve the early targets. 

Bridging the Gap: Budget Priorities for Lymphatic Filariasis 

When we talk about focused inclusivity, we refer to targeted budgetary allocations while also tackling the “neglect “once associated with lymphatic filariasis. Focused inclusivity for a disease like lymphatic filariasis involves a strategic and equitable approach to resource allocation and healthcare delivery services that ensures all affected populations receive the necessary interventions and support. 

The “Elimination of Lymphatic Filariasis” program has witnessed a notable surge in financial allocation, showcasing a commendable commitment to combat the disease. In four years the program witnessed a remarkable 300% increase in allocated budgets, reflecting a heightened prioritization of resources. 

Additionally, there has been an increase in budgetary utilization, with actual government expenditure rising to Rs 31.5 crores in 2018-19, a 17.5% increase from Rs 26.8 crores in 2017-18. This reflects a growth in utilization from 60% to 73%, indicating an enhanced absorption capacity by the states. 

Thus, financial inclusion for lymphatic filariasis encompasses two critical aspects: preventive therapy through Mass Drug Administration (MDA) and rehabilitation via Morbidity Management and Disability Prevention (MMDP). In both cases, the government assumes responsibility by bearing all the associated costs. 

MDA rounds are conducted biannually across endemic states and districts, with complimentary administration of drugs to interrupt disease transmission. The financial inclusion of states, based on their higher endemicity and burden, has been integral to charting a path toward early elimination; as seen since FY 2019-20, where both budget proposals and approvals saw substantial increases in high-burden states like Uttar Pradesh and Bihar. Notably, in FY 2022-23, the total approved budget for high-burden states was Rs 176.9 crores, representing 96% of the proposed amount.   

Focusing on rehabilitation, MMDP aims for efficient home-based management of disability for patients, distributing free disability kits to ensure relief for afflicted individuals. Effective morbidity management necessitates increased dissemination of MMDP toolkits and more training for both providers and patients. Bangladesh's success story, which eliminated LF in 2023, attributed its efforts to its morbidity management and disability prevention program, regularly updating data from endemic districts.  

India is witnessing similar progress in highly endemic states like Bihar. The Bihar Government’s implementation of a ‘disability certificate’ for people living with LF comes as a great relief to all patients who are eligible. Bihar’s progress, from issuing no disability certificates in 2021 to 3,721 in 2023, underscores the importance of sustainable financing to realize policy benefits. 

Linking financial assistance schemes for lymphatic filariasis-induced disabilities has become a priority recently. For instance, Andhra Pradesh has approved financial assistance of Rs 5,000 for bilateral elephantiasis Grade-IV patients, Telangana provides a monthly pension of Rs 2,016 to Grade-II onwards LF-affected individuals, and Tamil Nadu offers Rs 1,000 for Grade-IV LF cases. 

For many debilitating diseases, surgical procedures pose a significant economic burden.

However, the government alleviates this pressure by covering surgical interventions for Hydrocele under the Ayushman Bharat Scheme, providing hope and relief for those affected by the disease. 

To ensure LF receives the attention it deserves, further efforts and budgetary allocations are necessary for better outcomes. Continued research into biological markers and defining high transmission areas are essential. Allocating funds for advanced diagnostic tools ensures timely and accurate detection, leading to better disease management and prevention.  

Additionally, collective efforts by NGOs and private institutions through rapid investments in R&D, capacity building, and other initiatives are crucial. Partnering with non-governmental organizations, local communities and private institutions to supplement government efforts to increase the outreach and thereby impact of the program is a must. Prioritizing the budget for LF is not just a financial issue; it is a crucial step towards achieving social justice and economic stability.  

While India strives to meet its elimination goals, a focused and inclusive financial strategy can bring much-needed relief to those affected by this debilitating disease and finally overcome the long-standing neglect.  

As the nation looks forward to the second round of the bi-annual MDA round on August 10 across six endemic states, we anticipate a brighter future aimed at eliminating the disease ahead of the targets set globally.  

The author is former Director National Center for Vector Borne Diseases Control.

Views are personal and do not represent the stand of this publication.