Editorial: Setback to fight against TB

India has the highest burden, accounting for over 27% of the total cases in the world

The stoppage of funding by global health aid agencies and a web of bureaucratic procedures have pushed an ambitious national project to control tuberculosis into an uncertain future. The operations of the JEET (Joint Effort for Elimination of Tuberculosis) project, funded by international non-profit agencies and implemented by the Central Tuberculosis Division of the Ministry of Health and Family Welfare, face the danger of coming to a grinding halt at a time when greater surveillance is needed to detect TB cases in the country. India has the highest burden, accounting for over 27% of the total cases in the world. In 2020, the Centre identified 1.82 million cases but experts say there could be at least half a million more that slip through the cracks — patients who go to doctors in the private sector for diagnoses but never make it to the government’s database. Tuberculosis is no longer a disease of the poor. Undernutrition, indoor air pollution, smoking and alcohol addiction are barriers that stall TB elimination across socio-economic groups. Project JEET was launched in 2018 by three global health agencies — Clinton Health Access Initiative, Foundation for Innovative New Diagnostics and US-based non-profit PATH. Together, the three infused nearly $40 million till March this year. The project had roped in around 15,000 private doctors across 15 States and incentivised them to treat TB patients and inform the government about the status of their health. Under the project, private patients receive free, quality-assured diagnostic and treatment services.

After three years of funding and overseeing the project, the international agencies began the process of transitioning out on the funding front, largely due to the problems arising out of red-tapism. This left the responsibility of funding the project with the health ministry. A project of such an ambitious goal — elimination of tuberculosis across the country by 2025 — cannot yield the desired results unless the private sector is roped in, given the bureaucratic limitations. The private health sector in India serves as the first point of contact for over 60% of TB patients. Hence, it is critical to engage the private sector to effectively implement the standards of TB care. The pandemic has resulted in a delayed rollout of a domestically funded private sector engagement programme. Prolonged lockdowns and the restriction of many hospitals for only Covid-19 services, coupled with stigma among patients, pose challenges to the TB programme. In addition, the diversion of staff — primarily lab technicians — led to a significant fall in TB case detection. The pandemic forced several States to defer implementing the anti-TB programme. The way to bring the TB programme back on track is through rapid and intensified private sector engagement.

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