Kala-azar in India: A Public Health Challenge in Transition

INDIA’S ACTION TOWARDS ELIMINATION OF KALA-AZAR

A critical review of the programmatic management of kala-azar is essential to assess the effectiveness of existing strategies, identify operational gaps in coordination, logistics, and surveillance, and recommend evidence-based improvements necessary for the sustained elimination of the disease across endemic and non-endemic regions [Figure 1].^4,5

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Figure 1: Recommendations.

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PROGRAM MANAGEMENT – LIMITATIONS OF PROGRAMMATIC MANAGEMENT

• Effective program management is the backbone of the Kala-azar elimination campaign. While the strategy outlines collaborative roles between central and state governments, and external development partners, the World Health Organizations, non-governmental organizations, etc., gaps remain in coordination, logistics, and last-mile implementation.

• VL-human immunodeficiency virus (HIV) co-infection is particularly concerning, as the dual burden undermines Kala-azar elimination. Patients co-infected with HIV are more likely to suffer recurrent or chronic infections due to weakened immunity. However, existing surveillance systems often inadequately cover this aspect. Therefore, integrating HIV programs with VL surveillance, including cross-training of field workers and introducing joint monitoring frameworks, is vital for early detection and timely intervention. Box 1 highlights the key government initiatives taken by Government of India.

• Despite the presence of clearly defined operational activities (drug procurement, diagnostics, cold chain maintenance, etc.), actual ground-level execution often suffers from poor inter-departmental coordination, inconsistent supply chains, and delays in drug dispatch and usage reporting. Feedback mechanisms between field-level workers and district officials are weak or obsolete in several endemic districts.

• A key limitation is the absence of a centralized monitoring dashboard that integrates real-time data on cases, indoor residual sparying (IRS) progress, drug supply status, and relapse monitoring. Such a platform could facilitate evidence-based corrections in the program’s implementation strategies.

In summary, while the government’s efforts toward Kalaazar elimination are commendable, sustained progress will depend on agile program management, robust monitoring systems, inclusion of private health data, and innovative community engagement practices [Figure 1].