Out of the
estimated 8.8 million new tuberculosis (TB) cases worldwide, the World Health
Organization (WHO) reports that India continues to have the highest prevalence
of TB, with over 2 million cases reported in 2013 alone.
head-on and create a TB-free
India, on April 23, Jagat Prakash Nadda, the Union Minister for Health and
Family Welfare, India, launched a nationwide campaign 'Call To Action For A TB
Free India'. Nadda said, "The Indian government is committed
to end tuberculosis and ensure patients receive accurate diagnosis, appropriate
treatment and complete care."
announced the launch of a Missed Call Campaign, massive media campaign and
special strategy for addressing key populations. "We will launch a toll
free number soon where people can call for help and guidance. Even a missed
call will suffice. Our team will revert and ensure that the person is covered
by the program and gets free accurate diagnosis and right treatment for tuberculosis," added Nadda.
in Fight Against TB
India implemented DOTS —
Directly Observed Treatment, Short Course — a WHO strategy
that was launched as the Revised National TB Control Programme (RNTCP) in India
RNTCP provides treatment
for more than 1.5 million people annually. The nation-wide program has over
13,000 labs that examined more than 36 million people and detected more than
7.5 million TB patients in the past five years. It screens almost 25,000 people
for TB each day and detects, on an average, 3,000 positive cases.
"We have cured almost 20 million TB patients
and saved more than 3 million people. But we still have over a million patients
who are yet not under our fold," said Bhanu Pratap Sharma, Secretary, Health
Ministry. "Private sector should also ensure that TB cases are diagnosed and
treated according to the standards of tuberculosis care and guidelines."
Since the implementation
of RNTCP, services for drug-resistant tuberculosis and TB-HIV
care have been scaled up and made available across the country. More than
70,000 MDR-TB (Multi Drug Resistant TB) patients and 2,000 XDR-TB (Extensively
Drug Resistant TB) patients have been put on the standard treatment. NIKSHAY -
a real time case based, web-based TB surveillance system has been rolled out,
and the first ever and largest national drug resistance survey is already
underway in India.
primary challenge continues to be early diagnoses of tuberculosis. Dr. Jagdish
Prasad, Director General of Health Services, said that every single case should
be tested for drug resistance at the earliest possible. "This is more
cost-effective than testing them later when cases have become extensively drug
resistant," he said.
It's A Steep Climb Ahead...
reported that India tops the list of the world's 'missed' TB cases. Of the 9
million cases of tuberculosis in 2013, only 5.7 million were both detected and
notified to national TB programs. They were 'missed', either because they were
not diagnosed or because they were diagnosed but not reported. This is a major
Jose Luis Castro, Executive
Director, International Union Against Tuberculosis and Lung Disease (The
Union) said that newer challenges have made the fight against tuberculosis a tougher. "TB is becoming drug resistant,
people with diabetes are 2-3 times at higher risk, tobacco use is a common risk
factor for tuberculosis and other non-communicable diseases...if you're cured
from tuberculosis but continue to use tobacco, you're twice as likely to get TB
Nadda, however, has
promised to fight these challenges through the following:
of coverage of BCG vaccine under mission 'Indradhanush'
all TB cases and refer them to nearest public health center. For this
purpose, extensive use of point-of-care diagnostic kits will help
completion is satisfactory and will match international cure rates of
MDR-TB and XDR-TB
for new drugs and new drug regimens to achieve better regimens in short
indigenous development and manufacture of diagnostic tests under 'Make In
He said that the health
ministry will work out schemes and sensitize patients to help complete
treatment. "We need to link patients with various welfare schemes of the
government so that their earnings increase and ensure they have nutritional
support, which will enhance the immunity status of each member of the family."
Partnership to Fight TB
But the fight against TB
cannot be an isolated one with the government doing all the work. Anshu
Prakash, Joint Secretary, Health Ministry, explained, "Under the RNTCP, we have
formed a task force with WHO as its technical partner. USAID has committed $4.6
million funding and International Union Against Tuberculosis and Lung Disease
(The Union) will be its secretariat."
Prakash underlined the
three pillars in the campaign. "First, we should get everyone (who are not in
the program) under the program; second is an effective media and communication
campaign for TV, radio, print media, social media etc; and the last is to reach
the corporates and private sector for this initiative."
India also needs to find ways to increase domestic funding to ensure
that the 'Call to Action for TB Free India' is well-resourced. "We must mobilize a wide range of
stakeholders to demand and sustain high-level of domestic commitment to end
tuberculosis in India. We must also tap into the energy and influence of key
stakeholders to drive political, administrative, and technical solutions to
specific barriers affecting TB control in India," said Jamhoih Tonsing,
Regional Director, The Union.