The Hindu : Private participation in TB control mooted

Online edition of India's National Newspaper
Friday, Oct 03, 2003

Southern States

Southern States - Kerala-Thiruvananthapuram

Private participation in TB control mooted

By M. Dinesh Varma

THIRUVANANTHAPURAM Oct. 2. The Government is understood to be considering a proposal by the Indian Medical Association (IMA) to engage private hospitals and practitioners in the on-going Revised National Tuberculosis Control Programme (RNTCP) in the State.

The IMA, had in a project, proposed to set up district task forces to coordinate activities, sensitise and provide training for doctors in the private sector, supervise record keeping and generate reliable statistics.

The Government had given its approval in principle for the IMA project outlining an action-plan for extensive involvement of private hospitals in the RNTCP at a meeting chaired by the Health Secretary, K. Ramamoorthy.

However, the formal launch of the `public-private' mix to diagnose and cure tuberculosis patients in the State has been postponed from the scheduled October 2. ``The IMA will act as a catalyst and ensure the full participation of private hospitals in the initiative,'' R.V. Asokan, IMA spokesman told The Hindu. However, sources in the Health Department said the project was being reviewed and could be slightly revised before going in for full participation of private hospitals in the RNTCP as in the case of family welfare and polio eradication campaigns.

The IMA is pointing to the success in Kannur and Pathanamthitta, where private participation was carried out on an experimental basis. Dr. Asokan said the participation of private hospitals in Punalur had resulted in higher detection and excellent cure rates among the TB population. ``In fact, Punalur is the only place in the country to achieve full saturation levels vis-à-vis the participation of all the private hospitals in the programme,'' he said.

In Kannur, case detection rates had improved by 15 per cent after private hospitals and laboratories were included in the programme, he said.

According to Government estimates alone, over 30 per cent of TB patients are treated at private hospitals. There are four lakh TB patients already existing in the State. It is estimated that there are roughly 30,000 new TB cases annually. Around one lakh of the affected population are sputum positive cases, which are the most infectious in the community. A sputum positive patient going without proper treatment poses infection risks to an average of 12 persons a year. The programme, advocating the Directly Observed Treatment Short Course (DOTS) regimen based on a model formulated by the World Health Organisation (WHO), has been in progress since 1993.

Ever since it was launched in 1962, the National Tuberculosis Programme had been dogged by inadequacies in implementation, lack of adequate budgetary support, drug shortage and poor patient compliance. The number of TB patients also rose in proportion to the spurt in population along with patients who skipped doses developing multi-drug resistance.

And after 30 years of running the programme, an evaluation in 1992 by national and international experts, recommended scrapping the programme which had a dismal case detection and cure rate of under 40 per cent. The adoption of supervised short-course intermittent chemotherapy (Directly Observed Treatment) involves shorter duration (6 to 8 months as opposed to the conventional 18 months) therapy on a regimen of stronger drugs. This also involved the mobilisation of multi-purpose social workers on the basis of one supervisor for every five lakh of the population. It is pointed out that India has the highest number of TB cases in the world. Nearly 1.8 million persons develop the disease every year and around 4,50,000 die of it annually. There are 1,000 TB deaths every day.

The goals set by the programme are aimed at pursuing complete coverage by 2005, increase case detection rates to at least 70 per cent of the estimated cases, maintain the quality of monitoring, coordinate TB-HIV control efforts by strengthening partnership with AIDS control societies, and others.

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