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Controlling Tuberculosis: The Indian Way Ahead

Context: 

Tuberculosis is the worst endemic illness, claiming the lives of 1.5 million people each year (WHO). TB hits individuals at their most productive years, impoverishing the family and the nation. Every day, around 1,400 people die from tuberculosis in India, the world’s TB capital. These are just estimates since our healthcare system lacks a way of counting exact numbers.

Relevance:  

GS Paper 2: Issues relating to development and management of Social Sector/Services relating to Health, Education, Human Resources

Mains Question:

“Despite various efforts and policies, tuberculosis remains a major issue in India.” Discuss various explanations for this. Provide some prevention methods for tuberculosis.


The Initial Years

  • In the 1950s and 1960s, India was the world leader in TB epidemiology, transmission, and domiciliary therapy research.
  • The National Tuberculosis Control Programme of 1962 was a district-based programme with public-private partnership participation.
  • However, scaling up the model proved ineffective, and the initiative failed to control tuberculosis.
  • With that, we lost faith and started implementing what the WHO advised us to do under the Revised National TB Control Programme (RNTCP).
  • Without considering the disparities in TB epidemiology between poor and rich countries, WHO scientists designed RNTCP using a theoretical construct of TB control.

Revised National Tuberculosis Control Programme (RNTCP):

Based on the Directly Observed Treatment, Short Course (DOTS) strategy, the Revised National Tuberculosis Control Programme (RNTCP) began as a pilot study in 1993. It was launched as a national programme in 1997, although fast RNTCP expansion began in late 1998. In 2006, nationwide coverage was attained.

The Revised National Tuberculosis Control Programme has taken early and decisive efforts toward its goal of ‘universal access to early quality diagnosis and quality TB care for all TB patients.’ RNTCP is being implemented with decentralised TB detection services via 13,000+ designated microscopy centres and free treatment across the country via 4 lakh DOT centres.

Initiatives by India to combat TB

  • The Nikshay Ecosystem: This is the National Tuberculosis Information System, which is a one-stop solution for managing patient information and monitoring programme activities and performance across the country.
  • Nikshay Poshan Yojana (NPY): This scheme aims to provide financial assistance to TB patients for nourishment.
  • TB Harega Desh Jeetega Campaign: Launched in September 2019, it demonstrates the highest dedication to TB eradication.
  • Saksham Project The Saksham Project is a Tata Institute of Social Sciences (TISS) project that provides psychosocial counselling to DR-TB patients.

Flaws in the programme

There are obvious flaws in the RNTCP. 

  • There is no approved technique for monitoring the trajectory of tuberculosis control for a government-funded programme.
  • India believed treating pulmonary tuberculosis patients alone would suppress the disease was epidemiologically incorrect.
  • RNTCP has failed to evoke public participation in TB control.

Recognizing that tuberculosis was not under control, WHO asked for another programme amendment in 2014 through a World Health Assembly Resolution to eliminate tuberculosis by 2035. Emboldened by the possibility of an effective plan, India’s Prime Minister declared in 2018 that the disease would be eradicated by 2025.

 Controlling Measures

  • Control, elimination, and eradication are all examples of human supremacy over germs.
  • Control refers to reducing disease burden to a predetermined level in a predetermined period by specified measures.

§ Evidence must indicate that the decline was caused by those treatments rather than a ‘secular trend.’

§ Diseases with social determinants tend to reduce over time as housing, nutrition, education, and income improve – this is referred to as a “secular trend.”

§ By this ‘secular trend,’ the global TB burden had been declining by 1% or 1.5 % yearly.

Conclusion

The term “elimination” refers to achieving a zero frequency of new cases. We cannot eliminate TB because of the massive backlog of latent TB, but we must aim for a high degree of control (reducing from 200 per lakh cases per year to 50 per lakh cases per year) and document it with measurement. That will reflect the Prime Minister’s vision. High control is possible since we have significant assets through the RNTCP. 

Way Forward

  • Despite the significant results of the various programmes, significant efforts are required to enhance early and accurate diagnosis, followed by fast, suitable treatment, which is critical for eradicating TB.
  • India must participate in worldwide efforts to eliminate tuberculosis and a paradigm shift in control measures.
  • Under the National Tuberculosis Elimination Programme, there is a need to expand both the laboratory network and diagnostic facilities to cover the entire country. There is a critical need for the business sector to contribute significantly in terms of mandated tuberculosis notification and quality care.
  • There is a need to combat the stigma associated with tuberculosis so that every TB patient can seek treatment with dignity and without discrimination. As a result, advocacy, communication, and social mobilisation are critical.

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September 2022
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