Community as co-creator of solutions
This article is authored by Manmohan Singh, head, Aspirational Bharat Collaborative, Piramal Foundation.
India’s public health journey reflects remarkable resilience and progress. In 1947, life expectancy was just 32 years; by 2022, it had more than doubled to 70.19 years, an increase of over 100%. From eradicating polio to managing pandemics, and significantly reducing maternal and infant mortality, the country has achieved major public health milestones. These outcomes have been driven by sustained efforts from the ministry of health and family welfare and state governments through impactful programmes and initiatives.
To realise the vision of Viksit Bharat, lymphatic filariasis (LF) elimination must be seen not only as a health intervention but as a collective goal of sarkar, samaj and bazar.
Despite decades of effort, India still accounts for 40% of the global LF burden, a stark reminder that drug availability alone does not ensure uptake. During Mass Drug Administration (MDA) rounds, individuals are provided with three to eight tablets, depending on their height and age, to prevent LF. Critical surveillance protocols, such as the night blood survey, essential for detecting microfilaria (which circulates in the blood only at night). The hesitancy persists, driven by limited awareness, low perceived risk, and a deep trust deficit
To overcome these hesitancies, the approach must shift from viewing communities as passive recipients to active co-creators of solutions. This means:
- Going beyond the “what” to explain the “why” through a local influencer who community trust.
- Equipping frontline workers to listen actively, address concerns empathetically, and build trust.
- Partnering with local champions local NGOs, local volunteers, panchayat leaders, SHG members, faith leaders, teachers to co-design outreach and delivery plans.
By reframing LF elimination as a community-driven mission, India can move from compliance to collective ownership.
Backed by strong political will, the country is executing a five-pronged strategy:
- Mission-mode MDA
- Morbidity management and disability prevention
- Vector control
- High-level advocacy
- Innovation
In February 2025, the mission mode MDA campaign reached 17.5 crore people across 111 districts, driven by coordinated efforts and fixed biannual dates. Cross-ministerial last mile convergence especially with the education, health, WCD, youth affairs and panchayati raj ministries has amplified outreach. Schools serve as awareness hubs, while panchayati raj Institutions enable grassroots mobilization. This integrated approach is not only accelerating progress but also institutionalising the fight against LF, positioning India as a global leader in disease elimination.
Several process and policy decisions have helped institutionalise the efforts to eliminate LF. For instance:
- Fixed biannual MDA dates: February 10 and August 10 each year ensuring consistent and effective planning and implementation.
- Financial and medical support: The provision of disability prevention kits and hydrocele surgeries offers compassionate, and long-term patient well-being support to LF patients.
Trust is the cornerstone of any successful public health intervention. There is evidence in Bihar, and Jharkhand where collective efforts with community co-created solutions has built trust and smooth night blood survey being conducted as per protocols.
India’s LF elimination efforts are evolving from a model of top-down instruction to one of community-enabled action and co-designed solutions.
In Jharkhand, initiatives like Night Blood Survey Utsavs, turned a technical surveillance protocol into a shared civic engagement. In Odisha, the three-household visit model uses hyperlocal actors to reinforce messages through repeated, personalised engagement. In Kerala, NGOs helped scale lymphedema clinics across all districts, ensuring consistent and dignified access to care.
In Bihar and Jharkhand, block-level LF core groups are now integrated into routine health micro-plans, making them part of the everyday health delivery architecture. Bihar’s SuKrtya app and Jharkhand’s drug tracking system provides real-time monitoring, enabling faster course correction. Panchayati raj institutions are now deeply involved in expanding coverage and addressing refusals, showing how decentralised governance and data-driven tools can work hand in hand to strengthen last-mile delivery.
India’s ambitious goal of eliminating LF by 2027 requires continued partnership and shared responsibility, ensuring that every stakeholder Samaj, Sarkar and Bazar own a piece of the solution. Together, India is paving the way for a healthier, filariasis-free Bharat.
This article is authored by Manmohan Singh, head, Aspirational Bharat Collaborative, Piramal Foundation.
