TB notification may boomerang
By Shobha Shukla (Citizen News Service) & Bobby Ramakant (Citizen News Service)
GOVERNMENT BODY Indian Revised National TB Control Programme (RNTCP) sure needs to be complimented for making tuberculosis (TB) a notifiable disease. But there are words of caution of actions the RNTCP should consider to reach the unreachable population in need of TB services. Probably in response to the alarm bells that went ringing when Mumbai reported ‘total drug-resistant TB cases’ the government has taken the step to make TB a notifiable disease.
Making TB a notifiable disease, will perhaps yield some positive outcomes.
For instance, all private doctors or healthcare providers, laboratories and other caregivers will have to report every single case of TB to the government which will surely give a more real analysis of the burden of TB — where TB patients are getting treated and who is treating them, etc.
According to an advisory of Medicins Sans Frontieres (MSF) Access Campaign, Ashok Kumar, director general, TB division, Ministry of Health, said on a television channel, “It is essential to have compete information of all TB cases.
Therefore, the healthcare providers shall notify every TB case to local authorities, that is, district health officers or Chief Medical Officers of a district and municipal health officers, every month in a given format.”
But this may also boomerang — especially for those people who are currently inaccessible. They might be forced to go underground and refrain from accessing healthcare system.
According to the RNTCP, it had achieved a ‘new sputum positive TB case detection rate’ of more than 73 percent in 2010. This also implies that the RNTCP is not reaching to, at least, 27 percent of estimated number of people who need TB care services.
There is another brewing human rights question. With close to 1 lakh people estimated to contract multidrug-resistant TB (MDR-TB) in India annually, the RNTCP has provided standard treatment to only 3,610 patients since the inception of dots-Plus programme By its own admission, the RNTCP aims to deliver MDR-TB treatment to only about 30,000 patients by 2013 thus leaving out 70,000 people.
This is honestly, unacceptable in terms of public health as well as social justice.
When there will be no treatment provided by the RNTCP for every person who needs MDR-TB treatment, making every TB case notifiable, might have serious consequences for patients, their family and TB control in general.
Currently, MDR-TB treatment is available to less than 3 percent and 97 percent of those-in-need are denied treatment for MDR-TB. In communities identified to be at higher risk of TB, making TB a notifiable disease might not bear positive results.
Making TB a notifiable disease alone will not help unless accompanied by a very sensitive approach that ensures that no negative public health or social justice outcome, is allowed to negate the gains made by TB control in the past years. Genuinely engaging affected communities as equal partners, ensuring quality counselling, improving treatment and health literacy, and addressing TB related stigma will yield more sustainable public health and social justice outcomes.
The opinions expressed are the authors’ own.