TB kills, as Indian Govt fiddles with WB aid and red tapism

Dr Fabio Luelmo, who is part of the Indian segment of the WHO’s TB programme, says bureaucratic delays and the fact that TB control “is not a sufficient priority for the government” have been the chief obstacles to the implementation of the programme in India – the Revised National TB Control programme (RNTCP). Speaking to The Indian Express, Dr Luelmo said that there was no justification for this.He said that unlike many African countries and neighbouring Pakistan and Afghanistan “India does have money, the technical capacity, trained health staff, access to primary health care…”

The RNTCP, he said, was “only waiting for drugs and microscopes”. Delays, he said, generated other delays: “when you take a long time over anything, there are other obstacles… there is an election and for three months no one signs anything.” India has a $ 142 million World Bank loan for the TB control programme. The World Bank loan was cleared in February 1997. And, according Dr Luelmo, “one year later we don’t have drugs that should take three to five months to purchase in the international market.”

What is crucial is that he said that the World Bank loan would be suspended at the end of this month, unless the Indian Government can establish a private or public authority who will act as the purchasing agency for the TB drugs required to put the programme into action. The government asked the WHO to purchasethe drugs on its behalf, but, Dr Luelmo says, that this was not a function the organisation could perform. There were, he observes, other organisation or companies who specialised in such things.

The purchase of the TB drugs will, as it happens, also benefit Indian industry, which is very competitive in the international pharmaceuticals market. Even Dr Luelmo agreed that although the World Bank loan stipulated that India had to purchase the drugs through a global tender, and Indian company would be the most likely winner since by and large Indian companies had far lower costs.

The WHO’s TB control programme relies on health workers and trained volunteers observing and recording patients taking the correct dosage of anti-TB drugs, and noting when a patient has been cured. The programme has been found to work well in rich or poor, large or small countries.China is a good example of success of a large country, where the programme has now included over 50 percent of the population. The complete treatment oversix months costs under $ 20 (less than Rs 800) per patient.

A major problem with TB treatment until now has been that a majority of patients do not complete the course of medication. A 1992 evaluation of tuberculosis treatment in India found that only in one in three cases was the whole treatment completed. The other major problem in India, as elsewhere, has been that irregular treatment has generated drugs resistant TB bacilli, which the WHO feels could turn back the clock a 100 years in some countries, to a time when there were virtually no defences against the disease.

WHO says the governments of India, and 15 other countries which together account for 80 percent of TB cases across the world, are playing with health of people. Speaking at a press conference in London, Dr Arata Kochi, director of the WHO’s global tuberculosis programme, said, “It is very dangerous for the 16 countries to continue to ignore tuberculosis. It is becoming resistant to anti-tuberculosis medicines … this is dangerousfor the entire world. The tuberculosis bacilli do not respect national boundaries.”