This is an archive article published on September 26, 2018

Vast variation, significant deficits in TB care in urban India: Study

The findings are significant as they come ahead of the United Nations General Assembly’s first high-level meeting on September 26 that will focus on stepping up efforts to end TB.

4 min readPuneSep 26, 2018 09:03 AM IST

tuberculosis, TB deaths, tuberculosis deaths reduced, world health organisation, global tuberculosis, health news, who report, TB death report, India news

A doctor examines a tuberculosis patient in a government TB hospital. (Source: AP Photo/File)

Private practitioners in India are delivering a wide range of largely inadequate care to TB patients, says a new study in PLoS Medicine. The study, carried out in Mumbai and Patna, also found vast variation and significant deficits in tuberculosis care.

The findings are significant as they come ahead of the United Nations General Assembly’s first high-level meeting on September 26 that will focus on stepping up efforts to end TB.

Dr Madhukar Pai, director of the McGill International TB Centre, along with Ada Kwan, a PhD student at the University of California at Berkeley, Benjamin Daniels and Dr Jishnu Das from the World Bank, and other colleagues, utilised 24 standardised patients (SPs) — seemingly healthy actors trained to portray four different tuberculosis case scenarios during unannounced visits — to assess management and quality outcomes of private providers.

The results revealed that only a third of the standardised patients got managed correctly, and qualified doctors did a much better job than informal or alternative providers.

“The results were not that good,” Pai told The Indian Express via e-mail.

A total of 2,652 standardised patient-provider interactions were analysed across 473 providers in Patna and 730 providers in Mumbai. Providers correctly managed SP cases, in adherence to national and international standards, in only 949 interactions, found the study. In the other cases, providers often stuck to the same erroneous protocols, repeating their own observed actions 75 per cent of the time in a second visit by a different patient. However, there was no single and widely-adopted “common practice” among providers and SPs encountered a wide range of observed quality and various treatment protocols.

“There were also several positive findings,” said Pai. Researchers found that allopathic providers with Bachelor of Medicine, Bachelor of Surgery degrees or higher were far more likely to correctly manage cases than non-MBBS providers. They found that anti-TB drugs were used judiciously, with the correct regimen and dosage, in most cases.

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Providers who were presented with more diagnostic information by the patient offered better care, even if it meant referring their patients to the public-sector TB programme, found the study.

India accounts for a quarter of the world’s estimated 10.4 million new TB cases per year. It also accounts for nearly a third of 1.7 million deaths annually and a third of the estimated four million missing patients, who are either not diagnosed or not reported in national TB programmes. The private sector provides the bulk of primary health care in the country, serving as the first point of contact for 50 to 70 per cent of patients with TB symptoms, and prescribes nearly twice the amount of anti-TB drugs than in the public sector.

The Centre has also prioritised engaging the private sector in the national strategic plan for TB elimination.

“It is crucial for India to work with private health sector and make sure they are doing a good job of managing TB,” said Pai.

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To reach its goal of eliminating TB by 2025, the Union Ministry of Health and Family Welfare’s Central TB Division has tied up with several partners in 400 cities to support private practitioners treating TB patients. “We have intensified our engagement and while over 1.5 lakh private doctors are registered with the TB national programme, we have 25,000 regularly reporting TB cases,” said a highly-placed official.

Anuradha Mascarenhas

Anuradha Mascarenhas is a Senior Editor at The Indian Express, based in Pune. With a career spanning three decades, she is one of the most respected voices in Indian journalism regarding healthcare, science and environment and research developments. She also takes a keen interest in covering women's issues . Professional Background Education: A gold medalist in Communication and Journalism from Savitribai Phule Pune University and a Master’s degree in Literature. Author: She authored the biography At The Wheel Of Research, which chronicles the life and work of Dr. Soumya Swaminathan, the former Chief Scientist at the WHO. Key Focus: She combines scientific accuracy with storytelling, translating complex medical research into compelling public and human-interest narratives. Awards and Recognition Anuradha has won several awards including the Press Council of India's national award for excellence in journalism under the gender based reporting category in 2019 and the Laadli Media award (gender sensitivity -2024). A recipient of the Lokmat journalism award (gender category-2022), she was also shortlisted for the RedInk awards for excellence in journalism-2021. Her debut book At The Wheel Of Research, an exclusive biography of Dr Soumya Swaminathan the inaugural chief scientist of World Health Organisation was also nominated in the Popular Choice Category of JK Paper AUTHER awards. She has also secured competitive fellowships including the Laadli Media Fellowship (2022), the Survivors Against TB – New Research in TB Media Fellowship (2023) and is part of the prestigious 2025 India Cohort of the WomenLift Health Leadership Journey.” Recent Notable Articles (Late 2025) 1. Cancer & Specialized Medical Care "Tata Memorial finds way to kill drug-resistant cancer cells" (Nov 26, 2025): Reporting on a breakthrough for triple-negative breast cancer, one of the most aggressive forms of the disease. Discipline, diet and purpose; How a 97-year-old professor defies ageing'' (Nov 15, 2025) Report about Prof Gururaj Mutalik, the first Head of Department at Pune's B J Government Medical College who at 97 credits his longevity to healthy habits and a strong sense of purpose. 2. Environmental Health (The "Breathless Pune" Series) Long-term exposure even to 'moderate' air leads to chronic heart, lung, kidney issues" (Nov 26, 2025): Part of an investigative series highlighting that even "safe" pollution levels are damaging to vital organs. "For every 10 µg/m3 increase in PM2.5 level, there was 6-8% jump in medicine sales" (Nov 23, 2025): Using commercial data to prove the direct link between air quality and respiratory illnesses in Pune. 3. Lifestyle & Wellness News "They didn't let cancer, diabetes and heart disease stop them from travelling" (Dec 22, 2025): A collaborative piece featuring survivors who share practical tips for traveling with chronic conditions. At 17, his BP shot up to 200/120 mmHG; Lancet study flags why child and teen hypertension doubled between 2000 and 2020'' (Nov 12,2025)--A report that focusses on 17-year-old-boy's hypertensive crisis and reflects the rising global trend of high blood pressure among children and adolescents. 4. Scientific Recognition & Infrastructure For promoting sci-comm, gender diversity: IUCAA woman prof highlighted in Nature" (Nov 25, 2025): Covering the global recognition of Indian women scientists in gender studies and physics. Pune researchers find a spiral galaxy like the Milky Way from early universe'' (December 3, 2025)- A report on how Indian researchers discovered a massive galaxy that existed when the universe was just 1.5 billion years old , one of the earliest to have been observed so far. Signature Beat: Health, Science & Women in Leadership Anuradha is known for her COVID-19 reportage, where she was one of the first journalists to provide detailed insights into the Covishield and Covaxin trials. She has a dedicated interest in gender diversity in health and science, often profiling women researchers who are breaking the "leaky pipeline" in STEM fields. Her writing style is scrupulous, often featuring interviews with top-tier scientists and health experts from various institutions. ... Read More

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