Pulse

TB’s Ground Zero: action needed on a war-footing

MADHUKAR PAI | Updated on January 20, 2018 Published on March 26, 2016

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Adequate funding and modernisation of the existing programme are essential to control TB, especially the drug-resistant type

India is the world’s ground zero for tuberculosis, accounting for one-fourth of the global TB burden. In 2014, 2.2 lakh Indians succumbed to a curable disease. Furthermore, the threat of drug resistant TB is larger than ever and needs to be urgently tackled.

Earlier this month, Union Health and Family Welfare Minister JP Nadda and several Indian parliamentarians from the Global Coalition Against TB acknowledged the need to prioritise TB control and pledged their support towards achieving the Sustainable Development Goal for TB.

The Minister further added that the Revised National Tuberculosis Control Programme (RNTCP), the government agency responsible for TB control, “needs restructuring to make it more meaningful and private players need to be involved”.

If implemented at scale, the government’s commitment to increase private sector engagement to encourage standard TB care practices across the spectrum of healthcare providers can give a much needed boost to the country’s TB control efforts.

Funding woes

Simultaneously, the Health Ministry must increase its budget for the RNTCP. While delays at the state level in the release of allocated funds have hampered effective functioning of the national programme, the RNTCP has a history of being significantly under-funded. The allocation towards the RNTCP has consistently shown a trend of being lower than the required and requested amount. This is not surprising, given the overall under-investment in health by the Indian government.

I was a member of the Joint Monitoring Mission of 2015, a group of technical experts that reviewed the RNTCP’s performance last April. The findings by the Mission reveal that the while the country has made progress in reducing the TB burden, a minimum of Rs. 1,500 crore were needed by the RNTCP to execute its own National Strategic Plan 2012-2017. In 2014, the allocated amount toward the RNTCP was Rs. 640 crore while the requested amount was Rs. 1,358 crore – a shortfall of 53 per cent.

It is important to note that a large majority of patients visit qualified and informal health care providers in the private sector for TB care. Many studies have revealed a sub-optimal quality of care in this sector. A number of solutions are being tried out, such as the government-led private-provider interface agency models that are running in Mehsana, Nagpur, Patna and Mumbai. These projects have provided free TB drugs to privately treated patients, helped increase notifications, and have also helped improve treatment completion rates.

Another project is the Initiative for Promoting Affordable, Quality TB tests (IPAQT), a private lab network that has increased access to accurate diagnostics at lower costs. The government could evaluate these projects, and scale up aspects that have worked well. Clear guidelines can be established to hold the private sector accountable in such public-private partnership projects.

With the introduction of new diagnostics (e.g. GeneXpert), new TB drugs (bedaquiline and delamanid), and new adherence monitoring solutions and ICT platforms, India is well placed to design a comprehensive strategy to incorporate these into the RNTCP, and modernise DOTS services. These new tools will need to be made more affordable for the Indian public, in both public and private sectors.

Public awareness

Lastly, advocacy, is crucial to raise public awareness, and to galvanise political leadership. In the past year, TB advocacy has received a tremendous boost, with Amitabh Bachchan becoming an ambassador for TB control. A TB survivor himself, Bachchan has featured in a wonderful ad campaign that needs to reach all Indians.

If we are to protect the people of India from the spread of TB, and reach the ‘missing million’ cases, we must ensure access to quality, affordable TB diagnosis and treatment, regardless of where an individual seeks care.

The writer is Canada Research Chair in Epidemiology & Global Health at McGill University, Montreal. Views expressed are personal.

Published on March 26, 2016
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