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When Funds Are Available, Why Isn’t The Govt. Tackling This Deadly But Curable Disease?

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By Abhishek Jha

An Indian doctor examines sex worker Geeta Das who's suffering from tuberculosis at a health clinic for prostitutes in the eastern Indian city of Calcutta October 30, 2001. The United Nations said in a report in June that AIDS killed 310,000 people in India in 1999. REUTERS/Jayanta Shaw JS/DL - RTROT6B
Source: REUTERS/Jayanta Shaw

In October 2015, Maneka Gandhi, the women and child welfare minister criticised the Modi government publicly for having made budget cuts in the social sector to direct expenditure towards infrastructure. She was reported to have said that her ministry’s budget was slashed by half to $1.6 billion and that it had weakened her plans to fight malnutrition. “We still have problems because our cut has still not been restored. Literally, it’s a month-to-month suspense on whether we can meet wages,” she was quoted as saying.

A similar sort of problem could be plaguing India’s fight against tuberculosis. The 2015 annual status report of Revised National Tuberculosis Control Programme (RNTCP) for instance, states that the RNTCP “entered 12th Five year Plan (2012-17) with a budget of Rs 4500 crore”. The Minister of Health and Family Welfare, however, told the parliament in August last year that actual funds allocated for the period 2012-2016 were only Rs. 2263 crore and that the final expenditure by RNTCP was only Rs. 1623 crore.

Malnutrition, which according to Maneka Gandhi we aren’t fighting seriously enough, also makes people more susceptible to diseases. A targeted nutrition programme undertaken by the Central TB division, Director of External Affairs at Operation Asha Urvashi Prasad told YKA, could aid the tuberculosis treatment. The aforementioned RNTCP’s status report itself identifies lower BMI as a major attributable factor for poor treatment outcome in the case of Multi-Drug Resistance TB (MDR-TB). “Cumulative outcomes of 12,125 MDRTB patients have been reported till date out of which 5,796 (48%) have been successfully treated whereas 2,682 (22%) have died and 2,277 (19%) defaulted, respectively,” the report says.

Delay in receiving grants, shortage of health personnel, and lapses in proper monitoring of patients are also what Prasad told YKA are some of the issues that plague tuberculosis treatment in India. Therefore, although India has met its Millennium Development Goals in incidence, prevalence, and mortality rate, it is still ranked 15th among the 22 high burden countries in mortality rate per 1 lakh population in 2014 according to WHO’s Global Tuberculosis Report 2015.

A total of 14,45,284 cases of TB were registered under the Revised National Tuberculosis Control Programme (RNTCP) in India in 2014. We have, however, halved our rates of prevalence and mortality rate per lakh population since 1990 according to RNTCP’s annual status report of 2015.

The concerns raised by Prasad though remain, as does our burden.

A patient not finishing the DOTS treatment course is a huge cause behind this illness carrying on in the country. An e-compliance system that uses fingerprints to ascertain that all doses were taken by the patient under observation, Prasad told YKA, is therefore, important. This then requires the utilisation of funds to set up the system and health workers to work that system.

Funds are not the only problem, the method is too:

A scathing criticism of India’s policies for controlling tuberculosis has come from MSF’s Out of Step 2015 report, which surveyed the diagnostic and treatment practices for TB in 24 countries.

The WHO recommendation for rapid molecular tests as initial test has been adopted by India only for people at risk of MDR-TB or HIV-associated TB. The “roll-out has been progressing slowly, despite the establishment of clear and ambitious scale-up plans,” the report says.

Similarly, Category II treatment regimens containing streptomycin are still recommended in the country “despite their high burden of MDR-TB and despite recommendations for DST (Drug Susceptibility Testing) for those at risk of MDR-TB”. Also, for Drug Sensitive Tuberculosis (DS-TB), India still recommends intermittent therapy (three days a week) instead of daily therapy. The standards of TB care in India itself “envisages daily regimen for all TB cases” for which the National Expert Committee for Diagnosis and Management of TB has approved a 100 district pilot project according to RNTCP’s 2015 report. The Joint Monitoring Mission’s 2015 report too had criticised the RNTCP along similar lines.

Prasad from Operation Asha recommends that, apart from correcting the RNTCP’s course along the lines that it has been criticised, we need tailored programmes in local communities using school authorities, factory owners, community radios, etc to reach out to people and make them aware of the available treatment.

The stigma associated with TB is another hurdle, Prasad told YKA, that needs to be addressed if the existent government policies are to work. This would require, she said, a strong collaboration with non-state actors as well. When TB is, by the government’s own admission, “one of the leading causes of mortality in India”, killing “more than 300,000 people in India every year”, it goes without saying that the government should work against it with more seriousness.

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An ambassador and trained facilitator under Eco Femme (a social enterprise working towards menstrual health in south India), Sanjina is also an active member of the MHM Collective- India and Menstrual Health Alliance- India. She has conducted Menstrual Health sessions in multiple government schools adopted by Rotary District 3240 as part of their WinS project in rural Bengal. She has also delivered training of trainers on SRHR, gender, sexuality and Menstruation for Tomorrow’s Foundation, Vikramshila Education Resource Society, Nirdhan trust and Micro Finance, Tollygunj Women In Need, Paint It Red in Kolkata.

Now as an MH Fellow with YKA, she’s expanding her impressive scope of work further by launching a campaign to facilitate the process of ensuring better menstrual health and SRH services for women residing in correctional homes in West Bengal. The campaign will entail an independent study to take stalk of the present conditions of MHM in correctional homes across the state and use its findings to build public support and political will to take the necessary action.

Saurabh has been associated with YKA as a user and has consistently been writing on the issue MHM and its intersectionality with other issues in the society. Now as an MHM Fellow with YKA, he’s launched the Right to Period campaign, which aims to ensure proper execution of MHM guidelines in Delhi’s schools.

The long-term aim of the campaign is to develop an open culture where menstruation is not treated as a taboo. The campaign also seeks to hold the schools accountable for their responsibilities as an important component in the implementation of MHM policies by making adequate sanitation infrastructure and knowledge of MHM available in school premises.

Read more about his campaign.

Harshita is a psychologist and works to support people with mental health issues, particularly adolescents who are survivors of violence. Associated with the Azadi Foundation in UP, Harshita became an MHM Fellow with YKA, with the aim of promoting better menstrual health.

Her campaign #MeriMarzi aims to promote menstrual health and wellness, hygiene and facilities for female sex workers in UP. She says, “Knowledge about natural body processes is a very basic human right. And for individuals whose occupation is providing sexual services, it becomes even more important.”

Meri Marzi aims to ensure sensitised, non-discriminatory health workers for the needs of female sex workers in the Suraksha Clinics under the UPSACS (Uttar Pradesh State AIDS Control Society) program by creating more dialogues and garnering public support for the cause of sex workers’ menstrual rights. The campaign will also ensure interventions with sex workers to clear misconceptions around overall hygiene management to ensure that results flow both ways.

Read more about her campaign.

MH Fellow Sabna comes with significant experience working with a range of development issues. A co-founder of Project Sakhi Saheli, which aims to combat period poverty and break menstrual taboos, Sabna has, in the past, worked on the issue of menstruation in urban slums of Delhi with women and adolescent girls. She and her team also released MenstraBook, with menstrastories and organised Menstra Tlk in the Delhi School of Social Work to create more conversations on menstruation.

With YKA MHM Fellow Vineet, Sabna launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society. As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Read more about her campaign. 

A student from Delhi School of Social work, Vineet is a part of Project Sakhi Saheli, an initiative by the students of Delhi school of Social Work to create awareness on Menstrual Health and combat Period Poverty. Along with MHM Action Fellow Sabna, Vineet launched Menstratalk, a campaign that aims to put an end to period poverty and smash menstrual taboos in society.

As a start, the campaign aims to begin conversations on menstrual health with five hundred adolescents and youth in Delhi through offline platforms, and through this community mobilise support to create Period Friendly Institutions out of educational institutes in the city.

Find out more about the campaign here.

A native of Bhagalpur district – Bihar, Shalini Jha believes in equal rights for all genders and wants to work for a gender-equal and just society. In the past she’s had a year-long association as a community leader with Haiyya: Organise for Action’s Health Over Stigma campaign. She’s pursuing a Master’s in Literature with Ambedkar University, Delhi and as an MHM Fellow with YKA, recently launched ‘Project अल्हड़ (Alharh)’.

She says, “Bihar is ranked the lowest in India’s SDG Index 2019 for India. Hygienic and comfortable menstruation is a basic human right and sustainable development cannot be ensured if menstruators are deprived of their basic rights.” Project अल्हड़ (Alharh) aims to create a robust sensitised community in Bhagalpur to collectively spread awareness, break the taboo, debunk myths and initiate fearless conversations around menstruation. The campaign aims to reach at least 6000 adolescent girls from government and private schools in Baghalpur district in 2020.

Read more about the campaign here.

A psychologist and co-founder of a mental health NGO called Customize Cognition, Ritika forayed into the space of menstrual health and hygiene, sexual and reproductive healthcare and rights and gender equality as an MHM Fellow with YKA. She says, “The experience of working on MHM/SRHR and gender equality has been an enriching and eye-opening experience. I have learned what’s beneath the surface of the issue, be it awareness, lack of resources or disregard for trans men, who also menstruate.”

The Transmen-ses campaign aims to tackle the issue of silence and disregard for trans men’s menstruation needs, by mobilising gender sensitive health professionals and gender neutral restrooms in Lucknow.

Read more about the campaign here.

A Computer Science engineer by education, Nitisha started her career in the corporate sector, before realising she wanted to work in the development and social justice space. Since then, she has worked with Teach For India and Care India and is from the founding batch of Indian School of Development Management (ISDM), a one of its kind organisation creating leaders for the development sector through its experiential learning post graduate program.

As a Youth Ki Awaaz Menstrual Health Fellow, Nitisha has started Let’s Talk Period, a campaign to mobilise young people to switch to sustainable period products. She says, “80 lakh women in Delhi use non-biodegradable sanitary products, generate 3000 tonnes of menstrual waste, that takes 500-800 years to decompose; which in turn contributes to the health issues of all menstruators, increased burden of waste management on the city and harmful living environment for all citizens.

Let’s Talk Period aims to change this by

Find out more about her campaign here.

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A former Assistant Secretary with the Ministry of Women and Child Development in West Bengal for three months, Lakshmi Bhavya has been championing the cause of menstrual hygiene in her district. By associating herself with the Lalana Campaign, a holistic menstrual hygiene awareness campaign which is conducted by the Anahat NGO, Lakshmi has been slowly breaking taboos when it comes to periods and menstrual hygiene.

A Gender Rights Activist working with the tribal and marginalized communities in india, Srilekha is a PhD scholar working on understanding body and sexuality among tribal girls, to fill the gaps in research around indigenous women and their stories. Srilekha has worked extensively at the grassroots level with community based organisations, through several advocacy initiatives around Gender, Mental Health, Menstrual Hygiene and Sexual and Reproductive Health Rights (SRHR) for the indigenous in Jharkhand, over the last 6 years.

Srilekha has also contributed to sustainable livelihood projects and legal aid programs for survivors of sex trafficking. She has been conducting research based programs on maternal health, mental health, gender based violence, sex and sexuality. Her interest lies in conducting workshops for young people on life skills, feminism, gender and sexuality, trauma, resilience and interpersonal relationships.

A Guwahati-based college student pursuing her Masters in Tata Institute of Social Sciences, Bidisha started the #BleedwithDignity campaign on the technology platform, demanding that the Government of Assam install
biodegradable sanitary pad vending machines in all government schools across the state. Her petition on has already gathered support from over 90000 people and continues to grow.

Bidisha was selected in’s flagship program ‘She Creates Change’ having run successful online advocacy
campaigns, which were widely recognised. Through the #BleedwithDignity campaign; she organised and celebrated World Menstrual Hygiene Day, 2019 in Guwahati, Assam by hosting a wall mural by collaborating with local organisations. The initiative was widely covered by national and local media, and the mural was later inaugurated by the event’s chief guest Commissioner of Guwahati Municipal Corporation (GMC) Debeswar Malakar, IAS.

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