Government policies and interventions for development in various sectors and issues arising out of their design and implementation
Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources
Tuberculosis (TB) is a global pandemic and continues to be a huge public health threat in India. It currently has 27 per cent of the world’s new TB cases, which is around 2.8 million. According to World Health Organisation (WHO), the country holds the dubious distinction of being the TB capital of the world as around 480,000 people died due to the disease in 2014. As per Stop TB, 1:4 people with TB worldwide is an Indian.
Although the annual incidence of TB has reduced from 289 persons per 100,000 in year 2000 to 217 per 100,000 in 2015, eliminating TB would necessitate a dramatic reduction to less than one person per 10,00,000.
India’s vision: To end TB by 2025, five years ahead of the World’s Target under SDG’s
India’s estimated annual TB burden is 28 lakhs, 27% of the global total; our population is only 18%. Every day 1,200 Indians die of TB — 10 every three minutes.
According to Health Ministry data, only 63% of the patients infected with the airborne disease are currently under treatment. Further, 1,47,000 patients are resistant to first- and second-line TB medicines.
At the current rate of progress, global targets to eliminate TB by 2030 will be missed by a 150 years.
Tuberculosis (TB) is a disease caused by bacteria called Mycobacterium tuberculosis. The bacteria usually attack the lungs, but they can also damage other parts of the body.
TB spreads through the air when a person with TB of the lungs or throat coughs, sneezes, or talks. If you have been exposed, you should go to your doctor for tests. You are more likely to get TB if you have a weak immune system.
TB is, by and large, easily diagnosable and curable. It is unacceptable that it nevertheless remains the leading causes of death from any single infectious agent worldwide.
Each day, thousands of people with TB die, often because of inequitable access to quality diagnosis and treatment.
In addition, the rapid emergence of drug-resistant forms of TB (DR-TB) in many countries brings a fresh set of needs including new and comprehensive diagnostic tests and second-line TB drugs, and health systems trained anew to manage DR-TB.
Three processes: Infection, Progression, Transmission
Infection: Infection occurs when TB bacilli are inhaled. Bacilli may stay in the lungs or travel to other organs. Infection is lifelong, with bacilli lying dormant. This phase is “latent TB”, diagnosed by a tuberculin skin test (TST). The “annual rate of TB infection” (ARTI) is about 1%. Cumulatively, 40% to 70% of us are living with latent TB. From this reservoir pool, a few progress to TB disease, one by one, 5-30 years, average 20 years, later.
Progression: Progression occurs when bacilli become active, multiply and cause pathology; now we have “active TB”.
Transmission: When active TB affects the lungs, the bacilli find an exit route to the atmosphere, necessary for transmission.
Features of the National Strategic Plan for TB Elimination:
The plan aims to achieve a 100% case detection by 2020 and complete elimination of the disease by 2025.
Four strategic pillars of Detect-Treat-Prevent-Build (DTPB) have been developed for achieving the goals of the national strategic plan. The implementation will be the combined efforts of all the stakeholders.
It aims at creating a synergy through a shift from a regulatory approach to a partnership approach to stream line the services in the largely unorganized and unregulated private sector.
Anti-TB drug “Bedaqualine” has been introduced under the Conditional Access Programme (CAP).
A proposal is made to explore the possibility of development of a first line anti-TB drug in the public sector, under the “Make in India” programme.
Plan envisions a corpus fund for TB maintained under Bharat Kshay Niyantran Pratishtan (India TB control Foundation)
E-Nikshay an online platform has been made user-friendly, so as to let the doctors notify the cases as and when they come across the infected patients.
Various media campaigns have been planned to educate the masses about TB and its prevention. Swasth E- Gurukul is one such initiative of the World Health Organization.
The case of Metropolitan cities
Stats: In metropolitan cities such as Mumbai have the maximum share of drug-resistant TB cases, according to the Central TB Division’s India TB Report 2018. The city has higher levels of MDR-TB than in other parts of India, at 24-30% of new cases. Studies show that Mumbai also has 22% of notified cases of TB and around 50% potential drug resistance; TB treatment is estimated at 600 per 100,000 in slum areas and 458 in non-slum areas.
Factors: The reasons for such high incidence are manifold—overcrowded, congested conditions, poor access to healthcare facilities, migrants entering the city daily. Other factors are inadequate nutrition, lack of ventilated spaces, proximity to industry that makes people vulnerable to the harmful effects of pollution, and lack of accessible quality diagnostic services.
Solutions: Extending testing facilities under trained staff to government dispensaries and primary health centres is a must. Many lives can be saved if tests are cheaper, accurate and patients, particularly migrants, are given counselling and other forms of support.
The Way forward
The Revised National TB Control Programme has scaled up basic TB diagnostic and treatment services, however, it can’t beat the powerful bacterium unless we adopt an out-of-the-box approach.
There is a need to urgently increase funds for drug research, train health workers and technicians in accurate detection and increase counselling support for patients.
Based on the need expressed in the National Strategic Plan continue to increase the budget for the TB programme at the federal level and also at the state level to ensure no funding gap exists.
Scale up new rapid molecular diagnostics and new drugs and treatment regimen.
Ensure uniform good quality diagnostic and treatment services in both public and private sectors.
Scale up quickly the direct benefit transfers to patients and improve it further to ensure that out-of-pocket costs to patients and their families are reduced.
Implement the comprehensive approach of “search-treat-prevent” which is already in the national strategic plan. More needs to be done to operationalise prevention and preventive therapy for those at risk.
Considering the diversity of India put in place a system for achieving TB-free villages and cities, encouraging health competition between states and local areas.
Prioritise research and innovation, including research into new diagnostics, drugs and vaccine.
Most important of all set up a system of monitoring progress by the state chief ministers
