SHREYA KEDIA
It is indeed petrifying that India disproportionally bears the brunt of one-fourth of tuberculosis incidents around the world. A recent Global Tuberculosis Report 2016, released by the World Health Organisation (WHO) said that tuberculosis epidemic in India was larger than what was estimated. The country has 27 per cent of the global burden of tuberculosis cases and 34 per cent of global tuberculosis deaths. Out of 10.4 million new cases of tuberculosis in the world, India accounted for 2.8 million.
The WHO report came hot on the heels of a study published in August this year by Lancet, which revealed that the number of tuberculosis patients in India may be two times more than assumed. These reports only point towards the dysfunctional healthcare system in our country.
Given present estimates woefully outnumber past figures, tuberculosis remains not only a disease of the present, but also of the future. It especially affects the poor and the marginalised; it incapacitates families while leaving a devastating trail in its wake. Moreover, the costs associated with its diagnosis and treatment pushes patients into debt traps, often perpetuating a cycle of poverty. Ignorance, misconceptions and poor healthcare facilities remain major obstacles to effective tuberculosis prevention and control.
As pointed in the WHO report, there are gaps in reporting and testing of tuberculosis. There were about 28 lakh cases reported in India last year; 29 lakh in 2014. On an average, a patient suffering from tuberculosis is diagnosed after a delay of two months. The onset of tuberculosis is gradual and early detection is a problem. Also, people show up only in the later stages of the disease. With early diagnosis and treatment, the spread of the infection can be minimised. The good news is that, even though tuberculosis is a contagious disease, but unlike other air-borne diseases, it is completely curable. The bad news is that if delayed, it may result in less favourable outcomes and the possibility of its spread is more. Efforts must be made to reach out to the missing patients, improve diagnosis options and make sure that the infected take full course of treatment.
Also, national prevalence and drug resistance tests have not been carried out on a regular basis in the country. In the wake of rising cases of multi-drug resistant (MDR)-TB, the first national anti-tuberculosis drug resistance survey in India was launched in 2014. However, we failed to use this opportunity to provide for a national estimate on the prevalence of anti-tuberculosis drug resistance among new and previously treated patients.
The Revised National TB Control Programme (RNTCP), introduced by the Government to provide free diagnosis and treatment to the patients, received international acclamation. The RNTCP, along with its directly observed treatment Directly Observed Treatment Short-course (DOTS), has been the most cost-effective approach to combat tuberculosis in the country. But the service centres for these are either dysfunctional or overburdened. Poor and vulnerable people are forced to opt the services of the private sector which proves to be a costly affair. Moreover, there is a huge variation in the treatment given by the public and the private hospitals. More patients prefer getting treated and diagnosed at unregulated private hospitals. This often results in incorrect diagnosis coupled with expensive treatment.
A joint study by the Central TB Division, the Imperial College of London and the Bill and Melinda Gates Foundation has confirmed that many more tuberculosis patients seek treatment from the private sector than the Government hospitals. While the Government offers services free of cost to the people, more than half of the patients continue to opt for the unregulated private sector. Efforts must be made to regulate private sector hospitals and initiate measures to engage with Government initiatives.
The emergence of multi-drug-resistant tuberculosis (MDR-TB) has further complicated the tuberculosis scenario. MDR-TB is a form of tuberculosis infection that does not respond to the normal treatment regimen. Not only is it difficult to treat, but its treatment is far costlier than in the case of regular tuberculosis.
Tuberculosis is the deadliest among other air-borne diseases like chickenpox, influenza, measles, smallpox. India has a huge task ahead to control this disease, as the world community looks upon us to meet the sustainable development goal to reduce tuberculosis deaths by 80 per cent by 2030.
That not much has been done to control this disease is an indicator of India’s gargantuan failure on the public healthcare front. If India needs to stand by the millennium development goals, it needs to speed up efforts.
(The writer is a journalist with an interest in social issues)