In the recent End TB Summit held in New Delhi, Prime Minister Narendra Modi launched a campaign to eradicate tuberculosis (TB) from India by 2025, five years ahead of its globally set-deadline. Now, one might think that given 7 years we have in hand and support from the PM, this target is fairly achievable. Unfortunately, there are several reasons to believe why this is far from that if we consider how things are, at present.
India bears the highest global burden of TB, adding 2 million new cases every year. The number of deaths from TB reported each year in India is about 220,000, while the real number is believed to be even higher. India has an ongoing National Tuberculosis Program (NTP) since 1962 which later became the Revised National TB Control Program (RNTCP). The program aims to provide free of cost, quality diagnosis and treatment services across the country through the public health system.
If there is already a working system addressing the problem, then why is the incidence of TB not declining rapidly?
Under-staffing of the RNTCP
At the block level, people directly responsible for diagnosing TB patients and treating them are the Senior Treatment Supervisor (STS), Senior Tuberculosis Laboratory Supervisor (STLS) and Lab Technician. Moreover, one STS is in-charge of 3 blocks. They also have a list of other work like maintaining records, stock management, preparing reports, to name a few. Then there are voluntary health workers, like ASHA who are responsible for identifying patients as well as ensuring that they take medications and complete their treatment. If you consider the population of India and growing prevalence of TB, then it’s evident that these many people are not enough to tackle a disease whose duration of treatment can go up to 2 years.
Unavailability of Drugs
More often than not, the medicines are out of stock, in the government facilities. Many a times, the drugs reach the district but are not distributed in the blocks. There are no assigned vehicles to regularly transport medicines to all healthcare facilities. In many cases, drugs kept in the district, expire due to delay in paperwork, transportation and other unwarranted reasons. This leads to sheer wastage of already scarce resources, which ultimately affects the TB patients.
Unscrupulous Private Practitioners
An NGO providing free TB care in rural Bihar diagnosed a 60 year old woman named Shanti Devi suffering from TB. The woman, having little faith on government facilities, went to a well-known private doctor to be sure whether she has TB or not. The doctor saw the reports, run those tests again and said she doesn’t have TB, refuting the previous reports. He prescribed her 10 days of medication and asked her to come again for the next set of medicines, assuring that his treatment will cure her completely. The medicines prescribed to her were of TB (but not the correct dosage) along with cough syrups and liver tonics. A woman who could have gotten free medicines otherwise and get completely cured now runs the risk of developing drug resistant TB due to incorrect medication. This is not a single incidence. Many others like Shanti Devi are being duped by doctors who just want to exploit poor and illiterate people who trust them.
Poverty, Malnutrition and Poor Living Conditions
It’s safe to say that TB is a disease of the poor. In any society, it tends to impact heavily on the poorest and most marginalized groups. Since it’s a communicable disease, it’s more likely to spread among people who live and work in badly ventilated and overcrowded areas. People having a weak immune system run the risk of getting TB and their chances of complete recovery are low. They also do not get enough nutritional support while taking medications, which further leads them to suffer during the treatment duration.
These are just some of the issues around TB care in India which need to be addressed immediately. We need more people to work, to ensure that TB patients are correctly diagnosed and treated free of cost. High priority should be given to monitor whether patients take medications regularly and complete their treatment. The government’s supply chain management has to be improved to ensure drugs are available at the right place at the right time. If a packet of Kurkure and a bottle of Pepsi can reach every nook and corner of India, then maybe we need to learn from them. Doctors who are indirectly causing an increase in TB epidemic, must be held accountable. As a country, we need innovative ideas, not unrealistic deadlines if we want to see a TB free India in near future.