By Abhishek Jha:
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.
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.