The Indian healthcare system is crippled with multiple challenges and an ever-increasing disease burden. In addition, there has been a pattern of inconsistency in implementing plans at a national level.
India was declared polio free in 2014 by the World Health Organisation. This has been possible due to sustained efforts over three full decades. With the WHO and Indian government at the centre, this success was driven by mass media, influencers, non-governmental organisations and millions of health workers.
Is it possible to extend such an effort to tuberculosis? Why does tuberculosis continue to be a burden? A number of issues continue to plague TB control in India. If concrete measures are not taken today, India will soon be on a verge of an irreversible situations. The public-private partnership route has been successful in solving a few issues in India in various sectors, and it could prove to be a game changer in the health field as well, if we are able convince the 'people' to get involved.
Let us look at the top challenges:
• Stigma associated with TB
• Increasing burden of various types of drug-resistant TB
• Incomplete diagnosis
• Treatment of TB patients without any quality protocol
The Government of India along with the Revised National TB Control Programme (RNTCP) and the Initiative for Promoting and Affordable Quality TB Tests (IPAQT) is no doubt making some headway in combating tuberculosis. It is very reassuring to notice that the mortality rate associated with TB has come down in the past decade but there is very little being done to ensure that the infection spread is under control. Many people across India, especially in rural areas, still associate TB strongly with a stigma and shy away from seeking medical help until it is too late. It is important to spread awareness across the country; numbers need to be analysed and more health workers need to be deployed in areas where the incidence is high.
"In infections such as tuberculosis, it is important that patients are fully aware of the burden of the disease, the types of tests needed, the drugs used for treatment, duration of treatment, disease monitoring and treatment progression."
Another big challenge that India is facing is the lack of a proper protocol for either diagnosis or treatment. Any person with symptoms of TB should undergo diagnostic tests. If they are found to have the disease, they should be given drug resistance tests.
The tie-up with RNTPC and IPAQT is proving to be extremely beneficial as the GeneXpert test gives results within two hours, confirming tuberculosis and indicates whether it is a case of multi-drug resistant tuberculosis. This helps doctors take quick disease management decisions.
There have been cases wherein treatment is started with first line drugs but the patient is actually suffering from multi-drug resistant tuberculosis. The patient not only loses precious time in beginning treatment but also transmits the infection to others by the time he is diagnosed accurately and his disease is managed rightly. This is the root cause of the problem's amplification and there is an urgent need for absolute stringent protocols. India did the right thing in banning the serological test for TB in 2012 and more such steps need to be taken to ensure that the infection spread is brought under control.
India has a history of implementing vaccinations in the right way and the BCG vaccine that protects children against TB is a step in the right direction. This vaccine does not provide lifetime immunisation but is indeed very important for children due to their weak immune system. Treatment and disease management becomes difficult in children owing to the side effects of the antibiotics. The vaccine has definitely helped the nation curb infection and mortality rates in children.
Awareness is the first step towards good health. In infections such as tuberculosis, it is important that patients are fully aware of the burden of the disease, the types of tests needed, the drugs used for treatment, duration of treatment, disease monitoring and treatment progression. Health awareness on a large scale is required to tackle a burden like TB.
India needs to effectively engage the RNTPC with the private sector and bring key stakeholders together -- NGOs, research centres, health workers -- to map out a strong and efficient PPP model that can effectively implement a TB control programme on a national level.