The Comptroller and Auditor General of India (CAG) has pulled up the Brihanmumbai Municipal Corporation (BMC) for poor attendance of contractual doctors at seven Drug Resistance Tuberculosis (DR-TB) centres in the city. The CAG audit report of 2018-19 noted that none of the private doctors contracted by the BMC fulfilled the norm of a minimum of five visits per week.
Dadar DR-TB centre recorded 14 per cent attendance of the consulting doctor while Govandi 15 per cent, the poorest record among the seven centres in 2018. Both the areas are considered TB hotspot. M-east ward, which covers slum clusters of Govandi, Deonar, Baiganwadi, Mankhurd, Shivaji Nagar, Cheetah Camp, also has the biggest cluster of TB patients in the city.
The attendance records of the private practitioners were provided by the BMC’s health department to the CAG. The shortfall of visits was in the range of 70 to 87 per cent across seven centres.
“DR-TB centres are key in early detection of drug-resistant TB patients and their monitoring. In Mumbai, we are lucky to find premier institutes and private doctors willing to share knowledge and also work with the civic body. At the same time, it is difficult to find trained and competent doctors and lab technicians willing to work at DR-TB centres,” said Dr Ravikant Singh, founder of NGO Doctors For You that supports DR-TB centres in 200 districts across the country.
Set up under the Revised National Tuberculosis Control Program (RNTCP), DR-TB centres are responsible for ensuring patients’ adherence to the treatment schedule. As per the condition of appointment, each specialist should be available for at least five visits per week or more as per requirement. The practitioner should be available to attend emergency calls. With the presence of the centre in the locality, patients’ trip to the nodal centre in Sewree can be considerably reduced and follow up becomes easier.
However, the report noted, “Failure to report to the DR-TB on a specific date by doctors might have resulted in the patients coming to DR-TB unattended or his waiting time might have prolonged. Moreover, due to non-attendance of doctor on the specified date, if the patient had to make a repeat visit, it poses an additional risk of transmitting infection in travelling.”
While the contractual doctors were paid as per the number of visits to the centre, the CAG audit report, submitted to the civic body in March this year, said, Mumbai has the highest number of TB patients, and they should be attended on a priority basis.
As per the 2018 record, Mumbai accounts for 21 per cent of total TB burden in Maharashtra. However, it holds a larger population — 60 per cent of the state burden — when it comes to multi-drug resistant TB patients.
“The findings of 2018-19 might not be relevant now, as the pandemic has changed the entire situation. We are re-starting our efforts to encourage the private sector to report again at TB centres,” said Dr Daksha Shah, deputy executive health officer and former head of the TB treatment under the RNTCP.
In its reply, as mentioned in the report, the department stated that the matter would be verified and compliance would be furnished in due course.
Dr Kumar Doshi, Ghatkopar based consulting chest physician, said there has been considerable delay in diagnostics services during the lockdown. “During the lockdown, I ensured follow up of TB patients virtually and through phone calls. By end of April, we had started the OPD. There has been no decrease in the absolute number of TB cases, but a delay in diagnosis.”
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