India’s Fight Against TB: Why We Are Failing

TB care is not possible until the public and private players work together.

Tuberculosis or TB is a global health crisis that affects an estimated 9.6 million people in the world. 2.8 million of those affected are Indians, making India the TB capital of the world. The disease continues to spread at an alarming rate in the country, making it an epidemic.

TB brings suffering, devastation, poverty, debt and death, often to those who are already deeply vulnerable. Research has suggested a poverty spiral for those affected. Given that the disease affects productivity, increases debt, causes sale of assets and overall insolvency while grievously affecting their health. TB then is a matter of urgent concern for health policy in India.

The scenario for the ordinary Indian is bleak with regard to TB diagnosis and treatment.  Affected Indians are dependent on an ineffective Revised National Tuberculosis Control Programme (RNTCP), which is riddled with delays, mismanagement and inefficiencies. This, coupled with a lack of political will and reducing health budgets, has made India’s TB problem only worse.

An unsympathetic and ill-equipped public sector makes for a hostile environment and forces many to seek treatment in the private sector. Today, the largest section of the TB affected seek care – not with the RNTCP – but in the private sector. Here, the techniques used for diagnosis or treatments prescribed are often incorrect. Yet, the private sector is the first responder to TB patients when a government programme fails. This issue requires immediate attention as there is virtually no coordination between public and private sectors and patients in the private sector are left on their own.

Engagement and coordination between the two is urgently needed if we wish to control TB effectively. Experiments in Mumbai, Patna and Mehasana have revealed that this is indeed possible. In these cities, administrations have worked together effectively with the private sector ensuring reporting, appropriate and early diagnosis and treatment. This not only reduces costs and suffering, but also the transmission of TB.

This is particularly important with the rise of MDR-TB (Multi-Drug Resistant TB) which accounts for 3 per cent and 17-20 per cent of the TB patients in new and recurring cases. These are deeply troubling figures in real numbers.

MDR TB is harder to diagnose and more expensive to treat. Our neglect of TB has led to the creation of this crisis. Given the inability of existing policy to provide early and appropriate care to patients, this crisis is set to grow.

Affected Indians are dependent on an ineffective Revised National Tuberculosis Control Programme (RNTCP), which is riddled with delays, mismanagement and inefficiencies, writes Mr Deo.

It is time India took a hard look at its approaches, budgets and strategies for controlling TB.

The RNTCP was formulated in 1997 to focus largely on immediate diagnosis of patients with TB and to ensure the provision of targeted treatments. Yet, the largest numbers of those affected by TB seek care privately.

The public program is unable to inspire trust and offer care.  Over the years, the programme has evolved and its objectives have broadened to include standards of care and the need to push for public-private partnerships in the sector. The latter has become the RNTCP’s greatest failure.

The inability to broker a bridge between the two sectors for diagnosis, treatment and continued and monitored care is one of the greatest reasons for exploitation, unaffordable treatment and growing number of fatalities.

What comes as a bigger disappointment is how only a little budget is allocated to TB. The RNTCP’s annual budget of Rs 500 crore remains derisory with the least on each TB patient among the BRICS countries. Continued weakening of the programme through lack of funds is indicative of how there is only a little political will to improve the conditions of people affected with this disease. Despite this, our current government has ironically specified the goal of TB elimination by 2025.

If we want India to defeat TB, we should start with fulfilling the huge shortfall of funds to the RNTCP because they directly affect provision of the care to those affected and control transmission.

What we also need is a task force on TB that will include all stakeholders to prepare a plan to control TB. The health ministry is clearly unable to meet this challenge alone and urgently needs support from the private sector.

We need unwavering budgetary support and commitment to health system change. We need to urgently new technologies for diagnosis and new drugs for treatment.  We also need innovative patient care, continued follow up with patients, awareness and stigma reduction.

The digitisation and effective use of technology has shown dynamic results for TB world over. It is time India incorporates these evolving techniques for greater efficacy. Yet, nothing is possible until the public and private players work together. The effort for this will have to come from the government. Till then, India will continue to lose the battle against TB.

– Kalikesh Singh Deo is a second-time sitting Member of Parliament from Bolangir in Odisha and a prominent leader of the Biju Janata Dal. This blog is contributed under a campaign by Survivors Against TB
 which aims to bring together the patient perspective on TB.

 Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of NDTV and NDTV does not assume any responsibility or liability for the same.

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