A Listicle of the Schemes to curb TB
Tuberculosis, i.e. TB, is a severe infectious disease, with which the world is fighting for decades. India, most hit by TB giant, has seen its unpredictable outcomes and is still battling with it. The Indian government has designed and implemented several interventions, from the National Tuberculosis Program in the '60s to RNTCP to the latest National Strategic Plan, to eliminate TB. Every scheme has its positives and negatives. Bhanu Pratap Yadav lists top projects of the government to eradicate TB.
Disease Burden
TB can affect anybody, although it affects the poor disproportionately. Famous personalities like Kamala Nehru, S Ramanujan and Amitabh Bachchan all had TB. Stats from the Central TB Division, Ministry of Health says that in 2017, 100 lakh people were estimated to have developed TB in the world. Of this, 27.4 lakh cases are from India. This means out of every four people with TB in the world, one is an Indian.
The nation is also struggling with the Multi-Drug Resistant-TB (MDR-TB) burden having almost a quarter of the global disease load. Out of a total of 5.58 lakh cases of MDR-TB in the world, 1.35 lakh cases are reported from India. TB is one of the top 10 causes of death in the world. The number of deaths due to TB in the country in the year 2017 is 4.1 lakh which in comparison to HIV and malaria is much more.
Schemes/Programs to curb Tuberculosis
National Tuberculosis Program
National TB Program (NTP) was introduced in 1962 in collaboration with the World Health Organization to control TB. A joint review of the program in 1992 revealed some shortcomings in the program like managerial weaknesses, inadequate funding, non-standard treatment regimens, low rates of treatment completion, and lack of precise information on treatment outcomes.
Revised National Tuberculosis Control Program (RNTCP)
In the year 1992, NTP, with the inclusion of Directly Observed Treatment Short Course (DOTS) was revamped as the Revised National TB Control Program (RNTCP). The program, launched in 1997, covered the entire country by the end of 2005. During the second phase of RNTCP (2006-2011), the quality and reach of the services were improvised to achieve global case detection and cure targets.
National Strategic Plan (NSP) for Tuberculosis Control (2012-2017)
Despite RNTCP achievements, TB was declared an epidemic. So, to make “TB free India,” National Strategic Plan for Tuberculosis Control 2012-2017 came into implementation. NSP had a goal of 'Universal access to quality TB diagnosis and treatment for all TB patients in the community.'
Significant initiatives such as mandatory notification of all TB cases, integration of the programme with National Health Mission, expansion of diagnostics services, single-window service, and national drug resistance surveillance, were undertaken during this term.
National Strategic Plan for tuberculosis elimination (2017-2025)
The learnings, experience and success of NSP 2012-2017, evolved into NSP 2017-25. It is a three-year costed plan and an eight-year strategy to eliminate TB in India by 2025, five years ahead of the global target of 2030 under Sustainable Development Goals. This plan acts as a guidelines for all the stakeholders and redirects their attention to the most critical interventions and activities required to bring significant changes in the incidence, prevalence of TB, and the mortality caused by it.
The NSP 2017-25 has four pillars viz. "DETECT - TREAT - PREVENT - BUILD" (DTPB).
1. Detect
Detect every TB case by mandatory notification of all TB patients (especially among high-risk populations) from all health care providers. Moreover, a case-based web-based TB surveillance system called "NIKSHAY" is in place for all healthcare facilities. It provides patient support, logistics management, adherence support, and real-time tracking of a patient for Direct Benefit Transfer (DBT).
2. Treat
Those have been detected with TB, initiate the treatment by providing free TB drugs at the earliest. Ensure the completion of treatment under DOTS. The financial incentive of Rs.500/- per month is provided for nutritional support to patients throughout the treatment duration via Nikshay Poshak Yojana. Use of technology (IVR, SMS, Mobile apps) for treatment adherence.
3. Prevent
Measures are being taken to prevent the emergence of TB in susceptible population by Air-borne infection control, treatment for latent TB infection, and Addressing social determinants of TB.
4. Build
This is an important module of NSP 2017-2015 which focusses on building more relationships and partnerships, and strengthening the policies, empowering institutions and human resources to combat TB.
Advocacy, Communication and Social Mobilization (ACSM) is an essential and integral component proposed in the National Strategic Plan (2017- 2025). It creates positive behaviour change and empowers communities to change for long-term, sustained impact. This comprises of IEC material, audio-visual campaign on TV and radio; digital media campaign, outdoor media campaign, print media and social media campaign.
Public-Private Mix (PPM)
Government, beyond the centralized schemes to curb TB, has also partnered extensively with the private sector to make TB go way from India. The private sector too shared the responsibility in this combat against the disease. RNTCP has 22 partnership options to engage with NGOs and Private Practitioners. Some of the significant PPM projects are:
1. Project Axshya, meaning TB free, is a unique civil society initiative. It is implemented by The Union and World Vision India to provide quality TB care and support.
2. Challenge TB-India, where three partners play a significant role. The Union implemented Call to Action for a TB Free India initiative. FIND, under Challenge TB, primarily focuses on the expansion of access to rapid diagnostics, and outreach to vital pediatric centres. Under CTB-India, PATH enables early diagnosis, access to quality diagnostic, treatment modalities, and adherence to treatment for DR-TB patients in the private sector.
3. TB Call to Action in partnership with REACH, supported by USAID in Bihar, Jharkhand, Assam and Odisha. The objectives are to strengthen and support the community response to TB and to advocate for increased financial, intellectual and other resources.
4. Project Saksham Pravaah, a Tata Institute of Social Sciences (TISS) project, provides psychosocial counselling to DR-TB patient and caregivers based on the social structural approach to disease prevention and control.
5. Joint Efforts for Elimination of Tuberculosis (JEET), the largest private health sector engagement initiative for TB. It connects private hospitals, clinics, laboratories and practitioners with the national public health program to facilitate better access to affordable TB diagnostics, help patients stay on treatment while reducing treatment cost, and improve notification of TB cases. Partners in JEET are FIND, CHRI and CHAI.
6. Others Projects and Partnerships include TB Harega Desh Jeetega, Tuberculosis Health Action Learning Initiative with Karnataka Health Promotion Trust, TIE-TB project with ICMR, and World Health Partners.
The efforts reflect that the government is committed to ending the TB. But the road to make TB free India has many challenges - the present TB incidence decline rate of 2% per year (needs to be at 10%), delayed diagnosis, non-adherence to the treatment, risk of comorbidities with TB, social and economic effect associated with TB, control the number of TB cases (2019 has seen 17% hike in TB cases in a year), and the loopholes in the system. An ensembled, multi-pronged, inter-sectoral strategy with active participation from the community is much needed for the elimination of TB from the country.