|Demand of the question |
Introduction. Contextual Introduction.
Body. Reasons for poor TB control in India. Solutions for the same.
Conclusion. Way forward.
SDG 3.3 envision to ‘end of epidemic of tuberculosis by 2030‘. Tuberculosis is an infectious airborne bacterial disease caused by Mycobacterium tuberculosis, which most commonly affects the lungs but can also damage other parts of the body. According to WHO’s 2018 Global TB Report, India accounted for 27% of the total new TB infections in 2017, the highest in the world. The prevention and control of TB is a challenge, requiring the united efforts of all the stakeholders.
Reasons for failure of TB control in India:
- Poverty: The social conditions of millions of people in India is still far away from normal. Poverty is still a big problem in India associated with problems of undernourishment and poor and unhygienic living conditions. A majority of TB patients in India are due to to undernourishment. Further poverty impact their ability to get treated.
- Underreporting: One of the major factor of TB prevalence in India is under-reporting of TB cases. This leave risk of spread of TB to other healthy individuals.
- Wrong Diagnosis: Biomarkers and other diagnostics that identify individuals at highest risk of progression to disease are inadequate. Further doctors in India are less and untrained quacks most of the time mis-diagnose the disease.
- Treatment: Inequitable access to quality diagnosis and treatment remains a major issue in combating tuberculosis. Further, the private sector which contributes a major part of TB care is fragmented, made up of diverse types of healthcare providers, and largely unregulated.
- Drug resistance to TB: Standard TB treatment is not followed uniformly across the private sector, resulting in the rise of drug resistance. Patients on getting treated for symptoms do not follow the complete treatment dosage and regime. Due to lack of consistent follow-up of treatment regimens, situation often turn into Multi-drug resistance TB and Extreme-drug resistance TB.
- Outdated Drugs: The drugs used to treat TB, especially multi drug-resistant TB, are decades old. It is only recently that Bedaquiline and Delamanid (drugs to treat MDR-TB) has been made available. However, access to such drugs remain low.
- Issues with RNCTP: Weak implementation of Revised National TB control program at state level is another major concern.
- Other issues: Many other issues like human resource shortage, payment delays, procurement delays and drug stock-outs add to TB prevalence.
- Social Stigma: Patients often hesitate to seek treatment or deny their condition altogether for fear of social discrimination and stigmatisation.
Solutions to the issue:
- Government should build accountability among health professionals and ensure sufficient and sustainable financing to provide access to prevention and treatment.
- All hospitals should create an after care system in which every TB case should be followed up regularly at periodic intervals.
- It is important to address the social conditions and factors which contribute to and increase vulnerability to tuberculosis.
- Concerted efforts should be made to address the issues of undernourishment, diabetes, alcohol and tobacco use.
- We need to sensitise healthcare providers to issues faced by those with TB and ensure they act in a non-discriminatory manner.
- We must provide both treatment and legal literacy to people with TB, so that they understand their rights and can speak up if these are violated.
- It is important to invest more in R&D to come up with new drug regimens for responding to the spread of drug-resistant strains.
- Mass awareness campaigns against social taboos regarding TB should be done through media educating people about the disease, precautions and its cure.
Tuberculosis remains the biggest killer disease in India. It is the active involvement of TB survivors and champions that can give an impetus to a collective efforts to improve public understanding of TB, reducing stigma and prevent discrimination to end TB in India.