Every time I sit to discuss malaria eradication, I feel like getting lost in the ocean of issues that we, the so-called Population Medicine professionals, summarize as access (A), coverage (C), and utilization (U) problems.

This morning I woke up, planning to moderate a similar session– filled with confidence because I felt I knew the business. I was excited to rub shoulders with some prominent names in different sectors. Yet, I felt a bit dull because I thought it would be the same old mulling over– issues, possibilities, and what not!

I was wrong! And here is what happened.

Here is what jolted the conventional flow– "goalposts"! It's not that I didn't know it, but what struck me most was the difference in goalposts among the parties sitting at the table. 

I may sound a bit verbose here, but giving a little context is essential. In today's panel, I had,

1. a pediatrician turned legendary health systems expert supposed to talk about the health systems aspect of malaria elimination;

2. a renowned Internal Medicine specialist practicing in the national capital supposed to deliberate on issues related to the private sector;

3. a science communication expert supposed to enlighten us about the conduits in policy and science communication to prioritize malaria;

4. a Rotarian and industry leader supposed to talk about community awareness and Rotary's potential role, and above all,

5. an honorable Brigadier of the Indian Army supposed to bring us up to speed on how defense services combat malaria alongside fighting against the enemies.

We started with our usual tone and flow. Malaria No More India's Country Director, Mr. Pratik Kumar, opened by emphasizing the elimination priorities and highlighting the Malaria Mukt Bharat. 

Then I was called to do the "usual business". But, soon after I turned to the first panelist, Dr. Rajiv Tandon, for the first time, I felt like watching a 10-min documentary on India's healthcare delivery system. He emphasized the issue of silos between the informal private providers, formal private health agencies, medical colleges, and the public health system. Then came the climax! 

Before I could even acclimatize to this nonpareil illumination, Dr. Swati Maheshwari raised the point, which I felt was the point of the day. While there are myriad issues such as testing and treatment quality, adherence, drug resistance, non-reporting from the private sector, non-alignment with drug policy, and others, the bottom line was the standings and perception gap between the public and private health sectors. The most critical point that the doc has made is that when a patient comes to a doctor, it is all about treating the case and controlling the disease. And that hit me most because it means that as Global Health Strategists, as we claim to be, we have never been able to instill the public health priorities into a segment of healthcare delivery, catering to nearly two-thirds of the population. This sense of failure and incapacity questioned our very being of us and our boasting of inclusivity and universal health overage.

Helpless, I turned to the most experienced and trusted voice– Brigadier Dr. Sandeep Sinha, thinking that I would get the points of rebuttal to reassure my Health Strategist ego. And, I was wrong again! He was truthful, open, direct, and blunt like a commando. He talked about the systematic and disciplined monitoring and fidelity of implementation and the readiness to "roll up the sleeves", which the civil program and delivery can learn from the military. But, most importantly, he made a point, which I believe should be added to reform our notion as health strategists– "Accountability". Beyond the known A, C, and U problems that currently shape the public health policies and strategies globally, we must create accountability as a standalone core pillar of public health. The simple reason is that the strategic interventions that address the routine A, C, and U problems are insufficient to create, elevate and sustain accountability. And that is why we are still unable to develop a sense of ownership of the malaria elimination agenda among the people and the private health sector, even after a hundred years of battling the disease.

By now, I was feeling like getting entirely overwhelmed and overpowered by the fundamental gap in priorities. And then came the rescue! Mr. Deekshith Nevil Pinto and Mr. Palani Loganathan talked about two aspects of communications delivery– science to policy and program to people. It was never unknown to us that media shaped public opinions and priorities. But, it is shocking that before COVID, we never paid heed to the implications of using and misusing the information in public health. The conduit between science and policy is appropriate science communication. Likewise, strategic people's communication is the conduit between the policy and the public. A couple of things are essential here,

1. making the media sector aware of the correct information; and

2. making it accountable to deliver accurate information.

Pinto referred to a discussion with our CEO, Martin, to instantiate how a mosquito index could be game-changing in shaping public dialogue around preventive action. At the same time, he highlighted the need to make core health information accessible to the frontline journalist, who should be considered as necessary in public health as the frontline health workers. Similarly, Palani talked about the Rotary club and how it shaped and amplified the fight against Polio, one of the few landmarks that India has seen in public health since independence. 

The bottom line was that we must find the drivers and vehicles to set accountability among the people and private health sector if we are to end malaria in another five years. 

To me, the takeaway was even broader and more straightforward– I connected it to what Peter Brook said,

"The life of a play begins and ends in the moment of performance."

We have the stage prepared to end malaria, the drugs, diagnostics, and all the innovations, such as the vaccine, new nets, genetic technologies, and whatnot! What we don't have right now is the accountability towards a common goalpost. It's time the sectors must understand this challenge, break the silos, and end the poor man's disease. As health strategists, the ball is again on our court!