Public health services, which reduce a population's exposure to disease through such measures as sanitation and vector control, are an essential part of a country's development infrastructure. In India, policies have focused largely on medical services. Public health services, and even implementation of basic public health regulations, have been neglected. Various organisational issues also militate against the rational deployment of personnel and funds for disease control. There is strong capacity for dealing with outbreaks when they occur, but not to prevent them from occurring. Impressive capacity also exists for conducting intensive campaigns, but not for sustaining these gains on a continuing basis afterwards. This is illustrated by the near-eradication of malaria through highly-organised efforts in the 1950s, and its resurgence when attention shifted to other priorities such as family planning. This paper reviews the fundamental obstacles to effective disease control in India, which need to be dealt with on an urgent basis.
