Global funders want India to take lead in ending TB दुनिया से टी.बी. हटाने में भारत की भूमिका अहम

Global funders want India to take lead in ending TB दुनिया से टी.बी. हटाने में भारत की भूमिका अहम

India, which has the highest burden of TB, is also part of BRICS (Brazil, Russia, India, China and South Africa) nations which account for 46 per cent of all TB cases and 40 per cent of all TB-related mortality. Therefore, global funders want India to take the lead in ending TB, writes Aarti Dhar


he heads of Stop TB Partnership and the Global Fund – two major agencies which fund research on tuberculosis or TB – have proposed a meeting with Prime Minister Narendra Modi to appeal to him to focus on TB in a mission mode like is being done on sanitation under the ‘Swachh Bharat Abiyan’ to meet the target of ending TB by 2035 under the Sustainable Development Goals.

Global funders want India to take the lead in ending TB. India, which has the highest burden of TB, is also part of BRICS (Brazil, Russia, India, China and South Africa) nations which account for 46 per cent of all TB cases and 40 per cent of all TB-related mortality. One-third of the global missed TB cases are also in these five fast growing economies which have 43 per cent of the world’s population.

The Global Tuberculosis Report 2015, there were 220,000 TB-related deaths in India in 2014 and 2.5 million people lived with the dreaded disease. Should India achieve success in controlling TB—like it did in the case of polio—it would be easier for the world to deal with the disease.

According to the World Health Organisation (WHO), China and India alone account for almost 40 per cent of the estimated global burden of TB while South Africa accounts for 30 per cent of the global number of cases of TB-HIV co-infection. As far as multi-drug resistant tuberculosis (MDR-TB) is concerns, China, India and Russia together account for more than half of the estimated global burden. Brazil accounts for about one-third of the western hemisphere’s estimated burdens of TB and MDR-TB.

“We will not be able to end TB unless there is a paradigm shift in the strategies adopted to tackle the dreaded disease. And the world is looking towards India to take the lead in this,’’ says Dr. Suvanand Sahu, Deputy Executive Secretary, Stop TB Partnership. “We don’t expect outside funding all the time, but we know it can be done,’’ he says.

The two things that India needs to do immediately are first, to increase funding for TB research providing which needs to be doubled – both in private and public sector – and providing a uniform standard of care to the patients, Dr Sahu says while pointing out that there is a need to provide some kind of health insurance so that out-of-the-pocket expenses are cut down.

India needs to adopt a differentiated approach in TB care. “India is a vast country and it needs to adopt different models. There have been successful pilot projects but difficulty has been in scaling up,’’ Dr Sahu says.

In December 2014, Health Ministers from BRICS countries had made historic commitments in the fight against TB at the BRICS Health Ministers Meeting in Brasilia in Brazil where they approved the development of a cooperation plan that includes a common approach to universal accesses to first line tuberculosis medicines for all people with TB in BRICS countries, as well as in low and middle-income countries.

BRICS Ministers had agreed to establish a joint working group to devise a programme for combating tuberculosis, intensify action in their respective countries to end TB, and agreed to aspire towards Stop TB Partnership’s 90-90-90 TB target: 90 per cent of vulnerable groups screened, 90 per cent diagnosed and put on treatment, and 90 per cent treatment success as envisaged by the WHO. It was also agreed to cooperate on scientific research and innovations on diagnostics and treatment, including drug resistance and service delivery of TB.

“There are modern diagnostic tools like GeneExpert available but India is still using a century old microscope to diagnose TB. The entire programme in India looks old. India has missed the boat on modernizing. The Ministries of Science and Health need to focus more on indigenous vaccine development and product development, otherwise health will be missing from the county’s economic growth story,’’ says Prof Madhukar Pai, Director, McGill Global Health Programmes and Associate Director, McGill International TB Centre.

Both Dr Sahu and Prof Pai agree that there needs to be more activism on TB and more visibility in media. They say role models, champions and political initiative at the highest level could change the course of the debate on TB. Despite severe challenges, strategies have been employed to fight against TB. All five BRICS countries have utilized domestic funds in the fight against TB. In Russia, more than US $1 billion has been allocated to TB care.

On its part, India is working on TB models in Mumbai – which has the highest TB and MDR-TB burden in the country – Nagpur, Mehsana (Gujarat) and Patna (Bihar) for ensuring appropriate diagnosis and treatment to patients in both public and private sector.

In Mumbai, the Municipal Corporation of Greater Mumbai (MCGM) has successfully been running the pilot project in partnership with Private Practitioners Interface Agency wherein government and private doctors, and  pharmacists and chemists were trained on the standard of care on TB so that there is uniformity. The project is being run with the help of corporate social responsibility fund.

In Mehsana, the project is being run with public funding. Some earmarked chemists and pharmacists are asked to provide free TB medicine to patients for which they are reimbursed several times in a week and these activities monitored through online linking facilities which helps to ensure there are no drop-outs.

Since TB is a notifiable disease, doctors are expected to report the cases to the government which helps in monitoring. The district administration also conducted an audit of 125 prescriptions which found that only 4 or 5 had been put on second line of treatment which indicated that treatment protocols were being followed.

Not selling TB drugs over- the-counter would help in overcoming MDR-TB and ensuring compliance to regimen. “A personally believe that the sale of TB drugs in the open market should be banned,’’ says Dr. K.N.Sahai, State Programme Officer, TB in Bihar where a pilot is being run in Patna.

Aarti Dhar is a Delhi-based senior journalist who has covered a variety of social, developmental and political issues, which includes over two-decade-long association with The Hindu as Deputy Editor

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