India close to finding its ‘missing million’ TB patients

In a dramatic leap towards that aim, India has managed to trace 70 per cent — around 7 lakh TB patients — in the last year, with a combination of incentives for doctors, expansion of diagnostic network, nutrition support for patients and a legal provision to punish non-notification of patients by private sector doctors.

The last option, officers say, is a sparingly used provision — it is the incentives that have done the trick. Private sector providers are not only given incentives for notification of TB patients but the cost of treatment and test are borne by the government, even if the patient continues to be seen by the private-sector doctor. This, according to a senior official associated with TB control, was to ensure “that the doctor does not miss out on his fees etc. That would not work because our point is to reach the patients, see that they complete treatment”.

The official said, “In 2017, we had approximately 10 lakh missing TB cases (estimated 27.4 lakhs, detected 17.5 lakhs). In 2019, the gap has now reduced to 2.9 lakh cases (estimated 26.9 lakh, detected 24.03 lakh). Over the last two years, we have been able to track 10 lakh additional cases — 3.5 lakh in 2018 and 6.5 lakh in 2019.”

The National Strategic Plan for TB Elimination 2017-2025 says, “India has been engaged in TB control activities for more than 50 years. Yet TB continues to be India’s severest health crisis. TB kills an estimated 480,000 Indians every year and more than 1,400 every day. India also has more than a million ‘missing’ cases every year that are not notified and most remain either undiagnosed or unaccountably and inadequately diagnosed and treated in the private sector.”

In 2017, India started an initiative under which TB patients are given Rs 500 per month as nutrition support, as the disease is usually associated with undernutrition and low immunity. The public diagnostic network has been dramatically expanded, from 14,000 centres in 2017 to 20,000 at present.

According to Health Secretary Preeti Sudan, treatment compliance is very high at 85 per cent, and the number of drug-resistant TB cases is just a fraction of what it is in the western countries. “We have used innovative means such as TB fora and TB champions to reach the unreached and tracked 7 lakh ‘missing’ TB cases,” she said.