Flexibility and innovation in response to emerging infectious diseases: Reactions to multi-drug resistant Tuberculosis in India
Nora Engel
#2008-076
Emerging infectious diseases regained substantial international
attention in recent years and it has been argued that flexibility and
innovation in public health systems is needed in order to react to
changing challenges. This paper will take these policy claims as a
starting point to examine the case of multi-drug resistant Tuberculosis
(MDR-TB) in India. Based on fieldwork results it will be examined how
the existing control efforts of TB in India respond to the emergence of
MDR-TB, what solutions are discussed for diagnosing, treating and
preventing MDR-TB and what can be learned from that with regard to
innovation and flexibility of a public health system in a country like
India. The discussions and reactions to MDR-TB indicate that arguments
for flexibility meet constraints of the existing control system and the
Indian public health and wider social system. However, the flexibility
that is argued for goes beyond what has been envisaged in international
policy arenas (mainly focusing on preparation of various capacities in
surveillance, detection and research). Rather it involves localized
learning and experimenting within existing control structures that are
claimed to have become too rigid in trying to keep up quality standards
faced with a weakening public health system. Furthermore, the case shows
that existing challenges in TB control resurface with the emergence of
MDR-TB and reflect a difficult balancing act between biomedical values,
socio-cultural values and operational feasibility. However, various
actors are striving for change and it is in these instances that one can
start to understand what flexibility and innovation could mean for a
public health challenge such as TB in India. The paper concludes with an
argument for a detailed analysis of these changes from an innovation
perspective.
Key Words: Tuberculosis, Multi-drug resistance, India, Innovation,
Flexibility
JEL code classification: I18, O38
UNU-MERIT Working Papers
ISSN 1871-9872