India has the highest burden of Tuberculosis (TB) globally. A severe infectious disease, it continues to be a leading cause of disease and deaths. In India, the overall statistical data shows that every year about 20,00,000 people are infected with TB, and more than 3,00,000 people die due to low access to medical care and poor quality of treatment and care.
While 35,385 people were diagnosed with different forms of drug resistant TB labelled as DRTB. About 20,753 people were diagnosed with multi-drug resistant TB, defined as MDR.
Overall drug resistant tuberculosis has been found to be particularly high that continues to pose a serious health threat to the public.
While several measures have been taken by the government to control TB in India, the overall outcomes have not been comprehensive. The worst affected are those who reside in rural areas and urban slums. It has been found that in these unreached communities, families are both unaware about the disease and its impact as well as have no access to health care. Health workers do not reach these places located in villages and other rural settings. A majority of them are therefore at high risk of both morbidity and mortality.
To prevent tuberculosis from rising and becoming a major threat there is an urgent need to bring in new reforms in the pattern of health care. For instance, steps need to be taken to control the new forms of Tuberculosis that is emerging in regions where there is combined effects of poverty, migration, HIV co-infection and the development of drug resistance.
Even though several treatment protocols have been created to prevent and control TB, there is still a need to address multiple gaps that prevent the public from Tuberculosis.
Under the Revised National Tuberculosis Programme, some positive steps were taken such as adopting daily Fixed Dose Combination FDC regimen for drug-sensitive TB (DS-TB) treatment.
However, there is also a need to take more concrete steps since the treatment protocols being used in the national program are not often consistent with current scientific evidence and therefore there are gaps in these treatment measures, as a result it does not provide adequate health care for the population.
For instance, currently, single-drug formulations are being used for each of the drugs recommended for TB treatment. These drugs are administered three times a week. Patients are required to take seven or eight anti-TB medicines on alternate days of the week. For patients this is not only difficult and cumbersome, but it can also lead to developing drug resistance, which has a negative health impact.
The other four drugs used for Tuberculosis, which includes anti-TB drugs like isoniazid, rifampicin, pyrazinamide and ethambutol, recommended by World Health Organistion should also be used during the intensive phase of DS-TB treatment to ensure comprehensive care. For which there is an urgent need to create awareness in the public domain.
To break these barriers and ensure overall health care for Tuberculosis affected patients across all the states, especially areas where poverty is predominant, there is a need to accelerate the implementation of India’s new treatment protocols so that it bridges all the existing gaps and provides adequate healthcare for all and saves lives.
To identify the existing status of Tuberculosis, extensive qualitative fieldwork in India is required, which will help identify the overall status of Tuberculosis across all affected regions, especially in rural areas, which are often neglected.
The first step required to prevent Tuberculosis, is better case management across all regions where the disease is widespread. Currently the drug supply chain does not reach the peripheral areas as well as far reaching villages. Besides, there is limited information about the scale of the disease across many regions. Many are unable to afford the drugs, especially in remote areas and urban slums because cost of these medicines is high and there is limited awareness about ailments and health.
So it is essential that the public is provided with knowledge about the conditions that drives TB, especially in the public health context, which will help create awareness about public health challenge like Tuberculosis and potential threat such as multi-drug resistant TB and the steps that need to be taken to prevent and control the disease.
To reach the unreached, the Union Ministry of Health needs to provide medical care and drugs by distributing them across the most affected areas. The focus should also be the public sector, which should be provided with adequate funds to provide these medicines to the most impoverished and also drive them to identify the existing information on the extent of TB in these areas,
Besides, apart from identifying the overall status of TB related health conditions, engaging with the public will enable policy makers and health care providers, to ensure better delivery and health care.
Through these steps, the overall status of the community with regards to TB will be identified, which then will ensure better treatment and health outcomes and save thousands of lives.
Such measures will not only help in reaching the millennium targets but also help in fostering better capacity of a public health system and simultaneously contribute to better healthcare, the public sector and services. Only then will India’s population be able to fight and end tuberculosis especially among the most marginalized and ignored communities in the country.
Mohuya Chaudhuri is a senior journalist and researcher