India accounts for 27% of the world's 10.4 million new TB cases and 29% of the 1.8 million TB deaths globally. The Revised National TB Control Program(RNTCP) notified 1.75 million TB patients in 2016 and 33,820 drug- resistant TB patients were additionally notified. Needless to say that TB is India's "severest" health crisis.
In his Budget speech, Finance Minister had set a highly ambitious target of eliminating TB by 2025. Later, Ministry of Health and Family Welfare formulated National Strategic Plan(NSP) for the same and committed to achieve the target. This over-ambitious target,however, seems a piece of rhetoric considering government's attitude towards the disease control program in particular and health care system in general.
NSP plans to do away with the strategy of waiting for patients to walk in to get tested and instead engaging in detecting more cases, both drug-sensitive and drug-resistant. The idea behind this is to rapidly identify people with the disease and start them on effective treatment in order to stop the spread. A starkly contrasting example,however, was seen recently. An 18 year old girl,Multidrug Resistant TB patient from Bihar,was denied Bedaquiline,the drug for people who do not respond to any anti-TB medicine,on grounds of residence.By denying people access to this drug,which doubles the chances of cure,they are allowing MDR-TB to spread unchecked throughout the country.
As of now, Bedaquiline is provided in only six sites in the country in some specific conditions. The argument government put forward for the same is that it should only be used for the worst, most resistant cases.Now, the thing here to understand is that this practice actually increase the chance of generating BDQ resistance.The drug is used as a last resort for the most resistant patients. Those patients are usually very ill with severe lung damage.In that case, BDQ is less likely to be helpful and resistance is more likely to develop in those cases.
Secondly, India still lag behind when it comes to technological advancement in healthcare. India relies heavily on antiquated approaches including smear microscopy, intermittent drug regimens and paper-based reporting.Smear microscopy,undoubtedly,is a simple,rapid and inexpensive technique but it has significant limitations in its performance.Half million TB patients reach public health facilities but are not successfully diagnosed. When the diagnosis is not correct, how can we expect appropriate treatment?
India needs to scale-up rapid molecular diagnostics,make drug-susceptibility testing more widely accessible and switch to daily drug regimens. This kind of technological upgradation requires adequate funding which is,unfortunately,not available. Fund allocation to health sector is still not satisfactory and remains meagre at 1.4-2% of GDP.
This is not only about Tuberculosis.The government has prepared action plan to eliminate Kala-Azar,Filariasis and Leprosy as well.For this to happen, serious and sincere efforts are required. Need of the hour is to provide adequate funding,minimize implementational problems,technological advancement and make public health system efficient.
With this speed, India is less likely to eliminate TB by 2025
In his Budget speech, Finance Minister had set a highly ambitious target of eliminating TB by 2025. Later, Ministry of Health and Family Welfare formulated National Strategic Plan(NSP) for the same and committed to achieve the target. This over-ambitious target,however, seems a piece of rhetoric considering government's attitude towards the disease control program in particular and health care system in general.
NSP plans to do away with the strategy of waiting for patients to walk in to get tested and instead engaging in detecting more cases, both drug-sensitive and drug-resistant. The idea behind this is to rapidly identify people with the disease and start them on effective treatment in order to stop the spread. A starkly contrasting example,however, was seen recently. An 18 year old girl,Multidrug Resistant TB patient from Bihar,was denied Bedaquiline,the drug for people who do not respond to any anti-TB medicine,on grounds of residence.By denying people access to this drug,which doubles the chances of cure,they are allowing MDR-TB to spread unchecked throughout the country.
As of now, Bedaquiline is provided in only six sites in the country in some specific conditions. The argument government put forward for the same is that it should only be used for the worst, most resistant cases.Now, the thing here to understand is that this practice actually increase the chance of generating BDQ resistance.The drug is used as a last resort for the most resistant patients. Those patients are usually very ill with severe lung damage.In that case, BDQ is less likely to be helpful and resistance is more likely to develop in those cases.
Secondly, India still lag behind when it comes to technological advancement in healthcare. India relies heavily on antiquated approaches including smear microscopy, intermittent drug regimens and paper-based reporting.Smear microscopy,undoubtedly,is a simple,rapid and inexpensive technique but it has significant limitations in its performance.Half million TB patients reach public health facilities but are not successfully diagnosed. When the diagnosis is not correct, how can we expect appropriate treatment?
India needs to scale-up rapid molecular diagnostics,make drug-susceptibility testing more widely accessible and switch to daily drug regimens. This kind of technological upgradation requires adequate funding which is,unfortunately,not available. Fund allocation to health sector is still not satisfactory and remains meagre at 1.4-2% of GDP.
This is not only about Tuberculosis.The government has prepared action plan to eliminate Kala-Azar,Filariasis and Leprosy as well.For this to happen, serious and sincere efforts are required. Need of the hour is to provide adequate funding,minimize implementational problems,technological advancement and make public health system efficient.
With this speed, India is less likely to eliminate TB by 2025
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