TB patients must look beyond private sector for treatment

Tuberculosis or TB has emerged as a consistent threat in the landscape of Indian public health, with the nation carrying the highest burden of TB incidence. It is imperative that efforts to control and eradicate TB are addressed efficiently and augmented urgently, as at least 2.2 million lives perished in 2014 alone, owing to this deadly disease.

Though TB is an age-old ailment - preventable and curable - it is now the greatest killer worldwide. Furthermore, with many patients discontinuing the treatment for financial reasons, or as a result of a lack of proper supervision, the threat of drug-resistant TB looms large over the country.

This leaves patients with the risk of developing multi-drug resistant TB, which is not only difficult but also expensive to treat and can cause serious side effects. It is estimated that there were 24,000 new and 47,000 relapse multi-drug-resistant TB cases in 2014 - numbers which must be prevented from rising further at all costs and through drastic measures.

More than half of the TB patients in India seek care in the private sector and private healthcare providers are often the first point-of-care even for patients who are eventually treated in the public sector.

The reasons attributed to such preference for private healthcare providers include fear of stigma, lack of trust towards the public sector and low awareness, amongst others.

As a result, more than a million TB patients are either not detected by or notified to the Indian government's Revised National Tuberculosis Control Programme (RNTCP). These "missing million" TB sufferers are then left ailing in the unregulated private sector.

This often also happens because private healthcare providers fail to adhere to the established standards of TB care in India, leading to the larger risk of patients developing multi-drug resistant TB, again a major organisational and financial challenge for the RNTCP. Moreover, the lack of a regimen and accurate diagnosis continue to damage the cause of TB control in ungainly measures.

The Public Private Interface Agency (PPIA) model in Patna (Bihar) stands as an example of successful concerted energies fighting TB. The model illuminates how the use technology has been instrumental in receiving increased notification outcomes from the private sector and tracking adherence to standards of treatment.

Established in collaboration with World Health Partners, a local NGO, the Patna PPIA model shows how a holistic approach has helped in engaging existing providers, chemist stores and other diagnostic facilities using a technology-based reporting platform. The voucher system there was also labelled a success which has ensured that funds are transferred on time.

While in Patna, we met TB patients, who are receiving free medication through the PPIA model, and who had come forth to speak about their improved health conditions.

The TB laboratory and call centre which generate vouchers for free treatment and diagnosis, have further proven to be examples of effective and concerted efforts.

So far, 1,919 healthcare providers, including 601 formal providers, 545 informal providers, 643 chemists, and 130 labs have been engaged with, through the PPIA model.

Alongside, 12,616 patients have been notified to-date and 11,045 patients have been started on anti-TB drugs.

Case notification rates have also improved tremendously from 97 per 1,00,000 before the launch of the project to 386 per 1,00,000 at present.

With efficient health workers ensuring adherence to treatment and the implementation of measures to identify TB patients, the Patna prototype is an ideal one.

Such effective models are also functioning in two other centres - Mumbai in Maharashtra and Mehsana in Gujarat.

Another commendable initiative and benchmark in the battle against TB was the 46th Union World Conference on Lung Health in Cape Town, in South Africa, held in 2015. The event provided a strong platform to deliberate on the role of research and supportive policies to accelerate TB control.

Referring to the success of these models, the importance of using information and communication technologies was reiterated at the conference, with mention of how India can use its ready talent pool in this respect.

More recently, the Global Coalition Against TB, or GCAT held a meeting with MPs, in continuation of its endeavours to raise awareness about TB. Furthering the struggle, the Union health minister, JP Nadda and other dignitaries at the conference pledged to proactively fight TB in the country.

Barriers and affiliations must be transgressed while addressing a cause as urgent as TB control. It is only with the concentrated efforts of key stakeholders, healthcare professionals, non-governmental organisations and the pharmaceutical industry that an improved public private partnership model will work.

The need for dialogue and discussion in accelerating TB control must continue to be on our collective minds as long as we carry the burden of this disease.