How to tackle the dengue crisis in Bangladesh
The ongoing dengue fever outbreak in Bangladesh, with over 135,000 affected and a death toll nearing 1,000, is the latest in a series of crises which are testing the resilience and preparedness of our health system and exposing glaring gaps. Each of the 1,000+ deceased are beloved family members whose untimely loss has caused unimaginable grief and suffering, not least because the victims tend to be children and young adults.
Dengue, just like Covid-19, is not just a public health crisis but a glaring testament to the current lack of, and desperate need for, collective, coordinated, multi-sectoral action to deal with public health emergencies. While the immediate concern is the health crisis, the underlying issues are more complex and intertwined, which cannot be solved by any one actor alone, even if it is the omnipotent government.
The multi-faceted challenge
Dengue, a mosquito-borne disease, thrives in environments where the Aedes mosquito can breed. Urbanization, inadequate waste management, and lack of public awareness have inadvertently created such environments in Bangladesh. Puddles from the monsoon rains, coupled with poor waste management and vector control efforts, have turned urban centers into mosquito breeding grounds, and it is increasingly seeping into peri-urban and rural areas as well.
Experts are also saying that climate change and global warming are making the environment more conducive for Aedis Aegypti to breed, so unless a major shift in our approach to the disease is enacted urgently, we are only likely to see bigger and scarier outbreaks in the years to come.
The challenge isn’t just environmental, though. This is primarily a health emergency, and hence the obvious responsibility for dealing with the outbreak goes to the health ministry. However, if you look closely, vector control efforts such as the fogging of mosquito breeding grounds falls within the purview of the municipalities, which don’t report to or collaborate closely with the health ministry. The laws and regulations regarding insecticides are developed and enforced by the environment ministry, which, while successful in otherwise improving safety and efficacy standards, has led to a constrained supply of urgently needed larvicides to eliminate the mosquitoes.
Information and communications related to the outbreak could benefit hugely from the participation of the Communications ministry to leverage its relationship with the mass media channels, but again, they are not closely coordinating with the health ministry despite this undeclared complex emergency. The police, who are responsible for enforcing guidelines and making sure people are not ignoring their citizen responsibilities with regards to keeping their community clean and clear of stagnant water, are hardly brought into the decision-making and coordination apparatus, leading to poor enforcement.
All of that is just within the government. Then there are numerous other actors — the telecom companies, the NGOs, the civil society organizations, local youth groups, media channels and newspapers, health enterprises, local leaders and politicians, religious leaders — each of whom have an important role to play, but are rarely well-informed and coordinated to play their respective roles adequately.
We must remember that dengue is an unpredictable and as-yet-untreatable disease that can turn fatal rapidly, and as a result, prevention is our only locus of control. As a result of all of this miscommunication, misalignment, and miscoordination, we are utterly failing in the need to prevent this disease, and the health system, already stretched thin as an aftermath of the Covid-19 pandemic, is overwhelmed with the patient load, with many running out of essential resources, and fostering a black market for basic essentials like saline drips. Outside major cities, there’s a further gap in the medical community’s ability to handle such outbreaks, both in terms of knowledge and resources.
The need for collective action
Addressing this crisis requires a collective response. It’s not just the responsibility of the health ministry or the environmental agencies. Every sector has a role to play:
Government institutions: There’s an urgent need for better coordination between various government institutions. While the health department is on the front lines, urban planning, waste management, and environmental agencies play crucial roles in preventing and mitigating such outbreaks. Infrastructure development, especially efficient drainage systems and waste management, can significantly reduce breeding grounds for mosquitoes. The health ministry has an additional role in overseeing the coordination of various agencies and non-state actors, to prevent further escalation. They must be empowered to play this coordination role, in addition to equipping doctors and hospitals to respond adequately
Non-Government Organizations (NGOs): Community-based organizations and non-profits like ours (Jeeon Foundation) are already conducting awareness programs locally. However, more NGOs need to step in, not just with awareness campaigns but with tangible community-based action. This could include community clean-up drives, setting up temporary medical camps, and distributing mosquito nets and repellents
Civil society organizations: These organizations act as a bridge between the government and the public. They can play a pivotal role in both awareness and action. By organizing community meetings, they can educate the public, gather feedback, and through local advocacy ensure that government actions align with community needs
The public: The general public is both the most affected by and the first line of defense against dengue. Public awareness about this disease — and its multifaceted symptoms and risk profile — is crucial. Every individual needs to understand the importance of clean surroundings, the use of mosquito nets, the new and evolving symptom patterns of dengue, and early medical intervention when these symptoms appear. Moreover, community-driven initiatives, like neighbourhood clean-up drives, can make a significant difference
These actors can take leadership from their own vantage points, but leading and coordinating their efforts can make an outsized difference. A fantastic example for this from the Covid-19 times was the role played by the Savar Upazilla Health and Family Planning Officer Shaymul Huda, who led the coordination between various government and non-state actors to handle the pandemic with very limited resources. That experience has been turned into an Action Framework and Toolkit on “Community Engagement during Public Health Emergencies” through the government-led Risk Communications and Community Engagement (RCCE) pillar working committee during Covid — we must learn these and other lessons Covid-19 taught us and use it effectively to build our systems to be more resilient and effective against this and future crises.
The bigger picture
Therefore, while the immediate focus is on addressing the dengue crisis, there’s a bigger picture here. This outbreak is a symptom of a systemic issue — a lack of coordinated, collective action. Whether it’s dengue today or another challenge tomorrow, the need for multi-sectoral coordination and true participation and engagement of communities remains constant.
The ongoing dengue outbreak in Bangladesh is another wake-up call, especially for those who were sleeping through COVID-19. It’s a call for nimble collective action, for better coordination between various sectors, and for public awareness and active participation. Every stakeholder, from the government to the general public, has a role to play. It’s time to come together, not just to address the current crisis but to ensure that such crises do not recur every year. The need of the hour is not just action but coordinated, collective action.
Because no less than our nation’s children and future is at stake.
Rubayat Khan and Md Rafiqul Islam are Chairperson and Managing Trustee of Jeeon Foundation, respectively. Jeeon works on strengthening community-based health care delivery and training of primary healthcare providers (PHPs), and was a key contributor in the COVID-19 RCCE committee and the lead authors of the Action Framework and Toolkit on Community Engagement, which can be found at this link: https://doi.org/10.26180/23652156.v2 . They can be reached at rubayat.khan@jeeon.org and Rafiqul.islam@jeeon.org
Source: Dhaka Tribune.