At the End TB Summit, 2018, the prime minister of India made a bold commitment to end tuberculosis by 2025 — five years ahead of the global target. To many, this goal may seem unattainable, but as someone who has worked at the grass roots all his life and had the privilege to dream of a polio-free India — and work for it for almost two decades — I believe it is possible, if we come together as a country to fight TB the way we did for polio.
India still has the highest TB burden in the world and despite the disease being fully curable, people still die from it. TB usually affects people in their most productive years and drives families into debt. It has a direct link to human suffering, discrimination and also poverty. Due to its infectious spread, it directly affects our economic growth as well. But, with resilience, sufficient investment, innovative approaches and strategies and the participation of all stakeholders, TB can be defeated.
The first step is the creation of awareness and empowering of communities. TB affects millions, yet very few know enough about it. We need a multilingual, multi-stakeholder awareness effort to ensure that every single Indian knows about the challenges of TB and where to seek treatment. Today, with the expansion of the media, especially in regional languages, and evolving technology, we can reach everyone with the right information. This is the first step towards ensuring that people are empowered with the necessary information to identify and recognise TB symptoms, and seek diagnosis and treatment.
The second step is ensuring that we provide every Indian with access to correct diagnosis and treatment for TB, regardless of their ability to pay for it. This can only happen if we work with the private sector as we did in the case of polio. We need to go door to door, identify TB patients, and provide each of them care with compassion. Today, there are numerous innovative private sector programmes and partnership schemes for TB. These have been formulated keeping in mind the needs of the private sector and those of patients’ right to choose where to seek treatment.
I invite and urge the private sector to partner with the government. Our recently launched programmes for doctors and labs offer them various incentives and our health personnel are keen to work with them at all levels. We have made our processes simpler; we will make them simpler still. Even today, about half a million TB cases go unnotified, especially those seeking care in the private sector. We must track these missing cases and ensure that those in need of care and treatment are able to access it. We are also working with the private sector through organisations like the Indian Medical Association and Indian Academy of Paediatrics, to ensure patient-centric care as per “Standards of TB Care in India” (STCI). A key challenge is building a forward-looking plan to address and control drug resistance, a man-made menace that is a major roadblock in our fight against TB. Every TB patient must be tested for drug resistance at the first point of care, whether in the public or private sector, to rule out any drug resistance.
Sincere efforts are also being made to make our health systems more accessible and reliable. Our government wants to ensure that those seeking care trust us and get the appropriate care for completing treatment. We are striving to create more labs, point of care tests, an assured drug pipeline, access to new drugs and, most importantly, provide counselling and support for those affected.
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Every patient who is diagnosed late and does not receive timely treatment continues to infect others. How do we break this cycle of transmission? The government machinery at the field level should work with communities and provide free diagnosis and treatment to every affected individual. We also need to look beyond treatment. Recognising that medicines are not enough, we launched the Nikshay Poshan Yojana — besides numerous other schemes — under which TB patients receive Rs 500 every month while on treatment to ensure that the patients have economic support and nutrition during the required period.
We need to come together as a country to fight the disease and end the stigma surrounding it, so that every patient can seek care that is free from discrimination and with dignity. The community must act as a source of support for the patient. This will only happen as we educate more and more people about the nature of the disease.
On September 25, 2019, the ‘TB Harega Desh Jeetega Campaign’ was launched to accelerate the efforts to end TB by 2025. By employing a “multi-sectoral and community-led” approach, we are building a national movement to end TB by 2025. We have accordingly increased resource allocation towards the TB Elimination Programme four-fold and are confident of achieving our targets. The government has established a strong network of diagnostic and treatment centres, and all drugs and diagnostic are provided free to all types of TB patients.
The campaign aims to initiate preventive and promotive health approaches, and proposes potentially transformative interventions such as engagement with the private sector healthcare providers, inter-ministerial partnerships, corporate sector engagement, latent TB infection management and community engagement.
As long as our people continue to die every year from this preventable and treatable disease, we are failing in our duties as citizens, doctors, administrators and public health professionals. We must join hands to ensure a TB-free India. Each one of us can make a difference.
The writer is minister of health & family welfare, science & technology and earth sciences, Government of India
This article first appeared in the print edition of January 4, 2020 under the title “A long fight”