TB programme grappling with lack of funds; weak enforcement of standards another problem
An MDR-TB patient (Image courtesy: Partners in Health, pih.org)
A joint initiative of the government, independent experts and civil
society has found that multidrug-resistant tuberculosis (MDR-TB) is
emerging as a major health problem in India. Moreover, delay in
treatment of MD-RTB is the main reason behind increasing antibiotic
resistance, especially towards drug Rifampicin.
The findings have been established by Joint Monitoring Mission (JMM)
2015 of the Revised National Tuberculosis Control Programme (RNTCP). JMM
is an annual exercise that brings together national and international
experts, Union Ministry of Health and Family Welfare, civil society
members, implementation partners and developmental agencies to review
the progress of TB control efforts in India. The exercise is being
conducted for the last five years.
JMM 2015 was carried out in seven states across India to get a sense
of challenges being faced in elimination of the communicable disease.
JMM noted that the cost of providing MDR services is reaching 40 per
cent of the government’s total expenditure on TB since 2011 when it
first started treating MDR TB cases also. This threatens the future of
TB control in India and underscores the necessity to prevent drug
resistance.
The revised tuberculosis programme currently treats patients without
knowing their resistance profile. The present method of diagnosis
through microscopy of sputum cannot diagnose drug resistance. Only after
a patient stops responding to the regular treatment of thrice weekly
doses, tests for MDR are conducted.
What aggravates the problem is that regular treatment of patients
with prior resistance has often led to failure and amplification of
resistance to drug Rifampicin. The medicine forms first line of
treatment for TB. Once a patient gets resistant to it, he or she can
transmit MDR-TB to others who come in contact. Hence, it is important to
stop a patient gain stronger resistance and diagnose early so that
contamination can be reduced.
Private hospitals adding to problem
Another reason for spread of multidrug-resistant TB is lack of
regulation in private sector. Over 70 per cent people with TB first go
to private practitioners. JMM says that there too, substantial
diagnostic delays occur. Diagnosis and treatment are of variable
quality. This, combined with the absence of drug distribution controls,
leads to drug resistance.
In spite of mandatory notification, patients are not notified to the
RNTCP. The existing TB surveillance system lacks the capacity to count
the large pool of privately-diagnosed and treated TB cases hampering
timely interventions.
JMM 2015 noted that the ambitious National Strategic Plan (NSP) for
2012-17 lacks the much needed funds. While RNTCP expenditure has
increased 27 per cent since 2012, the gap between allocated funds and
minimum required investment to fulfill NSP 2012-17 is growing. If this
trend continues, final expenditure on the plan would be Rs 3,000
crore—two thirds of the minimum required. Thus, while bold policies are
in place, they cannot be implemented.
JMM has recommended that adequate funds should be ensured for RNTCP
and standards for TB care should be enforced throughout the country.
