The way to control tuberculosis

Source: The post is based on an article “The way to control tuberculosis” published in the “The Hindu” on 6^th July 2022.

Syllabus: GS 2 Government Policies and Interventions for Development in various sectors and Issues arising out of their Design and Implementation.

Relevance: Revised National TB Control Programme (RNTCP)

News: In recent years, WHO revised its target of TB elimination to 2035. Further, the Prime Minister also announced that India would eliminate TB by 2025.

Threat posed by TB

As per WHO, Tuberculosis is the worst among endemic diseases. It kills 1.5 million people every year. It affects adults in their most productive years. As a result, it impoverishes the family and the nation.

India is the TB capital of the world. In a gross estimate, it kills some 1,400 persons every day in India.

History of India’s TB control measures

In the 1950s and ’60s, India was the global leader in research in epidemiology, transmission and domiciliary treatment of TB.

In 1962, the government adopted the National TB Control Programme. It was a district-based initiative which strived to control TB with public-private participation.

Later on, the Indian government adopted the WHO’s Revised National TB Control Programme (RNTCP)

What are the flaws in the RNTCP programme which is being implemented in India?

The programme has been proved unsuccessful and the programme failed to control TB.

It has been developed with the help of a theoretical construct of TB control. It does not factor in the differences between the TB epidemiology of poor and rich countries.

In India, there is no prescribed method of monitoring the trajectory of TB control.

Till now, the Indian policy makers have assumed that treating pulmonary TB patients alone would control TB. However, it was an epidemiologically fallacious decision in India.

The programme has failed to elicit people’s partnership in TB control. Without people’s informed participation, there will be stigma and delay in seeking help to control TB.

Way Forward

Before the National AIDS Control Organization was established, the Indian Council of Medical Research (ICMR) used to work on it. It set up an AIDS Control Task Force which had a unique method of monitoring the control trajectory, popularly called ‘sentinel surveillance’. India can adopt the same method today.

India should design its own comprehensive strategy and point out the flaws in the WHO-designed RNTCP.

The government should focus on early diagnosis and treatment of the TB patients in order to curb TB through ‘source reduction’.

India should adopt its earlier AIDS Control Programme, in which public education was given high priority. For example, red ribbon clubs were established in schools and colleges.

In order to control TB, in addition to the specific interventions, the government should also work upon interventions such as the ‘secular trend’., for example, better housing, nutrition, education and income. Such ‘secular trend’ has reduced the burden of TB by 1% or 1.5% per year, globally.

The policy makers should first focus on a high level of control over the TB Cases rather than elimination (refers to achieving zero frequency of new cases). This is because India has a huge backlog of latent TB and it is not possible to eliminate TB in near future.

India should leverage Trained State and District TB officers, extensive network of TB clinics and an army of community and field workers.