India accounts for 27% of the world’s 10.4 million new TB cases and 29% of the 1.8 million TB deaths. The Revised National TB Control Program (RNTCP) notified 1.75 million TB patients in 2016 with 33,820 drug-resistant TB patients. Needless to say that TB is India’s “severest” health crisis.
In his Budget speech, the Finance Minister had set a highly ambitious target of eliminating TB by 2025. Later, Ministry of Health and Family Welfare formulated a National Strategic Plan (NSP) for the same and committed to achieve the target. This over-ambitious target, however, seems rhetoric considering the government’s attitude towards the disease control program in particular, and health care system in general.
Instead of patients waiting to walk in and get tested, the NSP plans to engage 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 to stop the spread of the disease. The case of an 18-year-old girl from Bihar, however, presents a stark contrast.
A patient of Multi-Drug Resistant TB (MDR-TB), she was denied Bedaquiline on grounds of residence. Bedaquiline is the drug given to people who do not respond to any anti-TB medicine. By denying people access to this drug, which doubles the chances of recovery, they are allowing MDR-TB to spread unchecked, throughout the country.
As of now, Bedaquiline (BDQ) is provided in only six sites in the country under some specific conditions. The government argues that it should only be used for the worst, most resistant cases. Now, what needs to be understood is that this practice actually increases the chance of generating BDQ resistance.
The drug is used as a last resort for the most resistant patients. These patients are usually very ill, with severe lung damage. In that case, BDQ is less likely to be helpful and resistance to the drug is more likely to develop.
Secondly, India still lags behind when it comes to technological advancement in healthcare. The country 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 a 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 upgrading requires adequate funding which is, unfortunately, not available. Fund allocation to the health sector is still not satisfactory and remains meagre at 1.4-2% of the GDP.
This is not only about Tuberculosis. The government has prepared action plans to eliminate Kala-Azar, Filariasis and Leprosy as well. For this to happen, serious and sincere efforts are required. The need of the hour is to provide adequate funding, minimize implementation problems, encourage technological advancement and make the public health system efficient.