Tuberculosis- Role of private sector in Elimination- Explained Pointwise

India has set an ambitious target to eliminate tuberculosis (TB) by 2025, five years ahead of the global target. The private health sector continues to provide more than 80 per cent of initial primary care in India. Hence, the private sector needs to be roped in the government’s programme for achieving the ambitious goal of elimination of tuberculosis in India.

What is Tuberculosis? What is the Current Status of Tuberculosis Burden In India?

Tuberculosis- Tuberculosis (TB) is an infectious airborne bacterial disease caused by Mycobacterium tuberculosis. It most commonly affects the lungs but can also damage other parts of the body.

Current Status of TB Burden In India

a. India has notified a record 25.5 lakh TB patients in 2023.( More than 8.4 lakh patients were notified by the private healthcare sector). This is a 21-fold increase from 2013 notified level.

b. According to WHO’s Global TB report 2021, with 25.9 lakh TB cases, India is home to 25% of the global tuberculosis cases.

What is the need for Eliminating TB earlier in India?

Eliminating TB earlier in India is crucial for a number of reasons which are mentioned below-

1. Health- TB is a major cause of illness and death in India, and eliminating the disease would significantly improve the health and well-being of the population.

2. Economic impact- TB has a significant economic impact, as it leads to loss of income and productivity for individuals and families. Eliminating tuberculosis would reduce this impact and help to boost the economy.

3. Poverty reduction- TB disproportionately affects people living in poverty, and eliminating the disease would help to reduce poverty and promote economic development.

4. Global health- TB is a global health concern, and eliminating the disease in India would contribute to the global effort to control and eventually eliminate TB.

5. Achievement of Sustainable Development Goals- Elimination of Tuberculosis is an important target under the United Nations’ Sustainable Development Goals (SDGs) and its elimination in India would contribute to overall progress towards the SDGs.

6. Social justice- Eliminating TB would help to promote social justice by reducing the burden of the disease on vulnerable and marginalized populations, such as those living in poverty or with limited access to healthcare.

What are the challenges in Eliminating TB in India?

1. High burden of TB cases- According to the Global TB Report 2022, India accounts for 28% of all TB cases in the world. This makes it difficult to identify and treat all cases in a timely manner.

2. Drug-resistant TB- India has a high burden of drug-resistant TB, which is more difficult and costly to treat than regular TB. Inadequate use of antibiotics and poor adherence to treatment regimens have contributed to the emergence of drug-resistant strains.

3. Limited access to healthcare- Many people, particularly in rural areas, lack the access to quality healthcare facilities or cannot afford to seek medical care. This result in delays in diagnosis and treatment, and may also lead to the spread of TB.

4. Stigma and discrimination- The stigmatisation of Tuberculosis has led to reluctance among the population to disclose their illness or seek treatment due to fear of discrimination or social isolation.

5. Poor living conditions- Overcrowded living conditions, poor sanitation, and lack of access to clean water can increase the risk of TB transmission.

6. Limited awareness- Many people in India are not aware of the signs and symptoms of TB or the importance of completing the full course of treatment. This leads to delays in diagnosis and treatment and contribute to the spread of TB.

7. Insufficient funding- Despite being a major health problem in India, TB receives insufficient funding and attention from policymakers and healthcare providers.

What are the government’s steps for Eliminating TB in India?

What is the private sector involvement in Tuberculosis treatment?

Public Private Interface Agency (PPIA)- The Public Private Interface Agency (PPIA) is the most effective form of intervention for elimination of TB. The agency functions as an intermediary between the national TB programme and private healthcare providers.

Patient Provider Support Agency (PPSA)- This has created a network of private health sector providers, including medical practitioners, retail chemists, laboratories, and corporate hospitals to ensure that diagnostic and treatment practices adhere to the ‘Standards of TB Care‘ in India.

What Should be the way forward?

1. Engaging better with private chemists- Retail chemists who are the first point of contact for patients in India who must be trained for regular monitoring of the H1 schedule and prohibiting over-the-counter sale of antibiotics.

2. Leveraging the contact of medical practitioners- The network of rural medical practitioners and village doctors have a high trust compact with the community, must be leveraged for TB detection and elimination.

3. Implementation of a comprehensive TB control program- The Indian government should develop and implement a comprehensive TB control program that includes early diagnosis, effective treatment, and follow-up care.

4. Investment in research and development- Investment in research and development can help to identify new diagnostic tools and more effective treatments for TB. For ex- The recent development of artificial intelligence software for detecting hot spots in the lungs from digital chest X-rays is a promising tool for mass active case finding of TB in the community.

5. Increase in govt funding- TB prevention and treatment should be a priority for the government and policymakers, and funding should be increased to support research, prevention programs, and treatment efforts.