Threefold rise in domestic budget for fight against tuberculosis:

Threefold rise in domestic budget for fight against tuberculosis:

Context

• According to a report from the World Health Organisation (WHO), India’s domestic budget for fighting tuberculosis showed a dramatic jump from about ₹700 crores in 2015 to ₹2,500 crores last year.

Why is it important?

• Most of India’s budget to combat the bacterial infection use to be dominated by international funding.
• For the very first-time things have flipped as domestic resources accounted for 74% of the $525 million spent in India last year, while it was only 38% in 2015.

Decrease in numbers

• In 2016, India recorded a 12% dip in the number of TB deaths from the previous year though the incidence dipped marginally by 1%.
• The number of notified cases of drug-resistant tuberculosis (MDR-TB) jumped from 79,000 to 84,000 in 2016.
• The use of molecular diagnostic tests has scaled up to detect the infection even on detection of drug-resistant TB, which is an improvement.
• India with 1.7 million new cases in 2016 continues to be the largest contributor to the global burden with up to a quarter of the 6.3 million new cases of TB.
• India accounts for about 32% of the number of people worldwide who succumbed to the disease.

Government initiative

• The government has committed to achieve a ‘90-90-90 target’ by 2035 i.e., 90% reductions in incidence, mortality and catastrophic health expenditures due to TB.
• The target is premised on improved diagnostics, shorter treatment courses, a better vaccine and comprehensive preventive strategies.
• However, several activists say that in spite of the government commitments, TB is still stigmatized and under-reported especially from the private sector and top-line drugs are still inadequate to treat people who suffer from the drug-resistant forms of the disease.

Directly Observed Treatment Short Course (DOTS)

• For the past two decades, India has slowly come to grips with regular strains of TB under a World Health Organization program known as DOTS or Directly Observed Treatment Short Course, in which patients are given free drugs but have to take them three times a week, in the presence of a health worker or volunteer, for at least two months.
• It involved a monumental effort perhaps bettered only by the country’s successful program to eradicate polio but India now meets global targets by detecting more than 70 percent of TB cases and curing more than 85 percent of those detected.

Multi-drug-resistant

• Although drug-resistant TB can be transmitted from patient to patient, regular strains of TB still dominate.
• Just 2 percent of new TB cases in India are found to be multi-drug-resistant; the majority of cases are in patients where the disease has recurred after unsatisfactory treatment.
• The problem of drug resistance is manageable, but it is growing and if controls are not introduced over use of antimicrobials [drugs] and people are not put into right treatment regimens, it will grow.
• Almost half of the six lakh rifampicin resistant multi-drug resistant tuberculosis cases in the world were in India, China, and Russian Federation.

What is Tuberculosis?

• Tuberculosis (TB) is a multi-systemic infectious disease.
• It is caused by a bacteria called as Mycobacterium tuberculosis.
• It is a communicable disease.

What are the causes of tuberculosis?

• Microscopic droplets: Tuberculosis is caused by bacteria that spread from person to person through microscopic droplets released into the air.
• This can happen when someone with the untreated, active form of tuberculosis coughs, speaks, sneezes, spits, laughs or sings.
• HIV and TB: Infection with HIV suppresses the immune system, making it difficult for the body to control TB bacteria.
• As a result, people with HIV are many times more likely to get TB and to progress from latent to active disease than are people who aren’t HIV positive.
• Drug-resistant TB: Another reason of tuberculosis is the increase in drug-resistant strains of the bacterium.
• Drug-resistant strains of tuberculosis emerge when an antibiotic fails to kill all of the bacteria it targets.
• The surviving bacteria become resistant to that particular drug and frequently other antibiotics as well.

What are the different types of Tuberculosis?

• There are many types of tuberculosis, but the main two types are termed as:
• Active tuberculosis infection: when the disease is actively producing symptoms, and can be transmitted to other people.
• Latent tuberculosis infection: when the person is infected with Mycobacterium tuberculosis bacteria, but the bacteria is not producing symptoms.

Other forms of Tuberculosis are:

• Pulmonary tuberculosis mainly infects the pulmonary system;
• Cutaneous tuberculosis has skin symptoms;
• Military tuberculosis describes widespread small infected sites.

WHO’s treatment guidelines for drug-resistant tuberculosis:

• The WHO treatment guidelines for drug-resistant tuberculosis (2016 update) contain policy recommendations on priority areas in the treatment of drug-resistant tuberculosis.
• The revision is in accordance with the WHO requirements for the formulation of evidence-informed policy.

The main highlights of the WHO guidelines, 2016-17 are:

• A shorter MDR-TB treatment regimen is recommended under specific conditions;
• Medicines used in the design of conventional MDR-TB treatment regimens are now reclassified to reflect updates in the evidence on their effectiveness and safety;
• Specific recommendations are made on the treatment of children with rifampicin-resistant or MDR-TB based on a first-ever individual patient data meta-analysis;
• Recommendations on the role of surgery in MDR-TB case management are included.

What is the Revised National Tuberculosis Control Program (RNTCP)?

• Revised National Tuberculosis Control Program (RNTCP) is the state-run tuberculosis (TB) control initiative of the Government of India.
• As per the National Strategic Plan 2012–17, the program has a vision of achieving a “TB free India”.

Objectives:

• RNTCP provides various free of cost, quality tuberculosis diagnosis and treatment services across the country through the government health system.
• The program uses the World Health Organisation (WHO) recommended Directly Observed Treatment Short Course (DOTS) strategy and reaches over a billion people in 632 districts/reporting units.
• It is also responsible for carrying out the Government of India five year TB National Strategic Plans.

Loopholes in the program:

• Though the Revised National Tuberculosis Control Programme (RNTCP) has treated 10 million patients, the rate of decline has been slow.
• RNTCP failed on universal access to early diagnosis and treatment and improving case detection.
• Also, India is far from reaching the 2030 Sustainable Development Goals, i.e. reducing the number of deaths by 90% and TB incidence by 80% compared with 2015.  

What is National Strategic Plan for tuberculosis 2017– 2025?

• The national strategic plan for tuberculosis elimination (2017-2025), has set a goal of “achieving a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB by 2025.”

Highlights:

• The TB control programme plans to do away with the strategy of waiting for patients to walk in to get tested and instead engage in detecting more cases, both drug-sensitive and drug-resistant.
• The emphasis will be on using highly sensitive diagnostic tests, undertaking universal testing for drug-resistant TB, reaching out to TB patients seeking care from private doctors and targeting people belonging to high-risk populations.
• The other priority is to provide anti-TB treatment irrespective of where patients seek care from, public or private and ensure that they complete the treatment.
• The TB control programme also talks of having in place patient-friendly systems to provide treatment and social support.