Why India is far from being tuberculosis free by 2025
This week, Prime Minister Modi is expected to inaugurate the End TB Summit being held by global health agencies in New Delhi. It’s an important event in the global health calendar as it takes forward the dialogue that began in the meeting of health ministers in Moscow last year.
The summit will also set the stage for a special session of the United Nations in September 2018 when TB will be discussed for the first time by heads of state in the General Assembly. Till now the UN has seen only five such high-level meetings devoted to health issues.
The objective of all these confabulations is to convince political leaders to make firm commitments to root out TB globally in a given time frame. There is a sense of urgency as TB is taking a high toll. It’s shocking that a disease which is fully curable in most cases kills 1,400 Indians every day.
India has made a bold move by setting the goal of eliminating TB by 2025. The vision is to achieve “TB-free India with zero deaths, disease and poverty due to TB” in less than eight years from now. It’s ambitious, given the current challenge — 28 lakh new cases and about five lakh deaths due to TB every year. An estimated 10 lakh cases remain undiagnosed or underdiagnosed, which experts refer to as "missing" cases.
To translate the vision of zero TB by 2025, the health ministry has prepared the National Strategic Plan for Elimination of TB (2017-2025). The current plan, like its predecessors, prescribes all the right things that need to be done, based on the concept of "detect, prevent, treat, build".
While the vision and strategic plan sound great, the situation on the ground is different. The TB control programme has been suffering on various counts. In 2013, the flagship national TB control programme was merged with the National Health Mission. The integration has adversely affected “the quality of the programme implementation because of multiple administrative, financial and operational functions to be carried out by field level staff,” according to health ministry’s own assessment.
Contractual positions in TB units are lying vacant, payment of salaries to staff in many states has been delayed and the health ministry’s tuberculosis division is understaffed. At the state and district levels, programme managers are burdened with administrative work leaving little time for supervision and monitoring. TB drugs continue to be sold over the counter due to weak implementation of drug regulation, adding to the problem of drug resistance.
An estimated Rs 16,649 crore will be required over the next three years to transform TB control and achieve the national goal of ending TB as a major public health problem by 2025, according to the health ministry. We are yet to hear from the finance ministry that this money will be allocated. Let’s keep in mind that sub-optimal investments will only yield sub-optimal results. A weak, underfunded and understaffed health system can’t be expected to eliminate a complex challenge like TB. Drugs and detection tools alone are not enough.
(Courtesy of Mail Today)