Tuberculosis is a preventable, treatable, and curable disease. India deserves to be applauded for fighting this debilitating condition on a war footing. However, we should not become complacent
The global health community pledged to cut tuberculosis deaths in half by this year. All eyes were set on India as it bears a disproportionately large burden of the world’s tuberculosis cases. Tuberculosis is one of the biggest health problems in India, where millions of people suffer from the disease.
Reducing tuberculosis is an enormous task not only for the Union Government but also for various State Governments, the private sector and the people in general. India has the highest burden of tuberculosis in the world, with a conservative estimate of more than two million cases being reported annually.
In fact, the World Health Organisation estimates that almost 3,00,000 people die of tuberculosis in India each year. India accounts for approximately one-fifth of the global incidence. Approximately, 40 per cent of the Indian population is estimated to be infected with tuberculosis, with increased risk of developing active disease.
While statistics still remain alarming, India has made great progress in tackling tuberculosis and saving the lives of its people. The Revised National TB Control Programme was launched in 1997, and was then expanded across India until the entire nation was covered by March 2006. This is no small feat and indeed; it’s an accomplishment worth noting.
To reach over a billion people, the RNTCP implemented the Directly Observed Treatment Short Course strategy, along with other components. The Directly Observed Treatment Short Course strategy has two main objectives: First, to achieve and maintain a tuberculosis treatment success rate of at least 85 per cent among new sputum positive patients, and second, to achieve and maintain detection of at least 70 per cent of the estimated new sputum positive people in the community.
In 2012, the RNTCP had a treatment success rate of 88 per cent of the new sputum positive patients and a case detection rate of 58 per cent of all the estimated tuberculosis cases in the community. Such an achievement proves that RNTCP services are extended to a vast number of people who are diagnosed with tuberculosis.
The RNTCP has also set many ambitious targets that have to be achieved by the end of this year. First is the early detection and treatment of at least 90 per cent of estimated tuberculosis cases in the community, including human immunodeficiency virus associated tuberculosis. Another important goal for this year is counseling and testing. A third target is the successful treatment of at least 90 per cent of all new tuberculosis patients and at least 85 per cent of all previously treated tuberculosis patients.
There is no doubt that the Union Government, in partnership with many State Governments, has taken the tuberculosis crisis seriously. This writer joins the entire TB community in recognising the efforts taken made by India. Real progress has been possible due to a political commitment and budgetary support for fighting the disease. The Government also had an important role to play in expanding the programme so as to provide universal access to high quality diagnosis and treatment across the public and the private sectors.
It is critically important that the disease control gains and mortality reductions made possible by the RNTCP be sustained and advanced through adequate financial investments and the engagement and alignment of the private sector. The private sector provides healthcare to a significant portion of the Indian population and, in order to truly offer universal access to quality care, all providers must implement the same standards for diagnosis, treatment and patient follow-up.
Efforts are already being made on this front at the State level. This includes developing public-private partnership models that extend free treatment to patients diagnosed and treated by private providers. Such strategies are expected to reduce costs for patients, thereby, improving adherence and, ultimately, treatment outcomes.
Recognition should also be given to recent progress in fighting the multi-drug-resistant forms of the disease, through adoption of new technology and innovations. India’s efforts are fully consistent with the WHO’s new ‘End TB’ strategy which positions the country as a trailblazer in adopting the new strategy and reaching ambitious targets.
The fight against tuberculosis has been waged for thousands of years. It will not go away in an instant. Yet, we cannot give up hope. Tuberculosis is a preventable, treatable and curable disease but complacency is our worse enemy. India should be applauded for the progress it has made so far, and it should not let the good work go waste.
(The writer is UN special envoy on TB)