With drug-resistant TB rising, monitoring pvt doctors is a challenge

Even two years after making it mandatory for doctors in private practice to report tuberculosis cases, the Government is finding it difficult to monitor the cases.

Only about 60,000 patients treated privately over the last two years have been notified with the Government, an official familiar with the issue told Business Line. Admitting this was a small number, the official said, there are about five lakh registered doctors and anyone could be treating a patient for TB, anywhere in the country.

It becomes even more worrisome, as an estimated 10 lakh patients are treated in the private sector, even as 15 lakh get treated in Government hospitals, the official added.

The Government made TB a notifiable disease in May 2012 to better manage TB diagnosis and treatment across the country – their main worry being, the dangerously rising incidence of drug-resistant TB.

Drug resistance occurs when patients stop taking the TB medicine prescribed by a doctor or when they take it erratically. Implement and enforce

Merely notifying the disease is not enough, the Government needs to enforce it too, says Madhukar Pai, Professor with Canada’s McGill International TB Centre. The next step is to implement standard treatment guidelines to treat TB, he added.

In fact, the Government is expected to announce the standards for TB care on Monday, to mark World TB Day.

Private practitioners may be wary of reporting the disease to the Government, fearing confidentiality of their patient or they could be uninterested in undertaking documentation and paperwork that they see as un-remunerative, Pai observed. Some doctors may still not know that reporting has been made mandatory, he says, adding that there is no excuse for private hospitals and diagnostic centres for not reporting back to the Government.

Cautioning that the unregulated sale and inappropriate prescription of TB drugs in the private healthcare sector was playing a significant role in the emergence of drug-resistant TB, Médecins Sans Frontières (MSF or Doctors without Borders) urged the Indian drug regulator to intensify its monitoring of TB drugs.

A TB specialist with MSF in India, Homa Mansoor observes that over the last 14-odd years, they have seen prescriptions from private health providers that were completely inappropriate.

“For example we have seen many prescriptions that prescribe three out of the four first-line TB drugs in combination with a quinalone (antibiotic),” she points out.

Lack of oversight from the drug regulatory authority makes even basic treatment of drug-sensitive TB difficult to monitor.