At the recent “End TB India Summit”, PM Modi declared intent for eliminating the disease by 2025, five years ahead of the global target.
But despite the well intentioned push from the highest levels, there are considerable challenges that make reaching the target uncertain.
What are the concerns?
TB is a highly stigmatised and omnipresent disease in India.
It kills over a 1,000 Indians every day despite being a curable disease.
But approach towards the disease remains disempowering and paternalistic, and is largely oblivious of the multiple parameters involved.
Infrastructure - Accurately diagnosing, recording all diagnosed cases and treating the most vulnerable communities has been challenging.
While private sector is the dominant player for TB treatment in India, many hospitals do not have a proper TB protocol, which is worsening the situation.
Partnerships to tackle TB with communities, the private health sector, government and other stakeholders remain weak.
There is thus a need for an expanded and inclusive strategy for TB, backed by sufficient funding and rigorous implementation.
Patient - The most troubling aspect of TB in India is the lack of patient cooperation to ensure proper and continued treatment for the full course.
Patient continuance for treatment is a challenge because TB treatment is long drawn and affects one's earning potential drastically.
Hence, while millions get affected, diagnosis and sustained treatment is pathetic as even accessing free treatment is financially burdening.
What is the way forward?
Expanding Care - It is important to talk to TB survivors and affected communities and identify the exact hurdles for getting themselves treated.
Expanding the treatment apparatus to vulnerable population clusters and enhancing accesses to remote terrains could help in bridging the gap.
Simultaneously, it needs to be recognized that poor nutrition, unplanned urbanisation, and limited public awareness feed the epidemic.
Empowering communities, and making cities more liveable and healthcare more accessible and affordable for all are also essential.
Technical Aspects - Drug resistance is a serious issue and calls for moving away from standardized regimes for drug selective and targeted treatment.
High incidences of ‘multi drug resistance’ (MDR) warrants an upfront drug susceptibility test (DST) for all TB patients to identify the exact strand of TB.
Further, new drugs that have the potential for curing the most resistant TB strains should be made available under controlled conditions.
