CHENNAI : In Chennai, the legendary dichotomy between the north and south of the city manifests itself even in tuberculosis control.

Only, it may come as a surprise that North Chennai seems to be faring better than the South, in terms of case detection and cure rates.

While the overall current case detection rate (74 per cent) and cure rate (88 per cent) indicate much progress, public health experts point out that North Chennai belt, roughly marked from zones 1 to 5, fares better than zones 6 to 10 of its southern counterpart. And, the main hurdle that keeps South Chennai from catching up with the case detection and cure rates that North Chennai has managed to achieve, is, the private practitioner.

Significant progress

If, in the North, significant progress has been made in case detection and cure rate, it is largely because for people of the area, the government hospital is the first line of care because of their economic status, K. Karunakaran, Programme Officer, Revised National Tuberculosis Control Programme (RNTCP), Chennai, says.

However, a study conducted by the Tuberculosis Research Centre (TRC) has established that the first point of contact for many patients is the private sector. About 45 per cent of men and 63 per cent of women go to the private physician for the first time. The problem arises because the majority of the private sector is not involved in the RNTCP, M.S. Jawahar of the TRC said.

The RNTCP uses the Directly Observed Treatment Short Course Therapy to encourage adherence to treatment regimens and accelerate cure of TB. "It is the best public health model available - globally accepted standard for diagnosis and treatment of TB," Subramania Raja, World Bank consultant on Public Private Mix, RNTCP, says. The benefits of using DOTS have been proven, with increased cure and detection rates being achieved wherever implemented.

In Chennai, with a detection rate of 74 per cent, over 25 per cent of those with TB are still in the community spreading the infection, Dr. Karunakaran says. In South Chennai, cooperation from chest physicians is poor. They prefer not to use DOTS or refer patients to the government sector, in contrast to the more cooperative private sector in North Chennai, he adds.

There are crossover patients to the government sector, but they come only when they are unable to afford the drugs. Default on care is common in TB treatment and without supervision and follow-up (as provided by DOTS), patients' condition worsens, they turn resistant to drug regimens and cure is delayed, he says, adding that the gap between the two sectors must be bridged. He sees a crucial role for NGOs in this.

Notifiable disease

"Public health programmes are often seen as the government's job," says Nalini Krishnan, Director, Projects, REACH, an NGO working in the field of TB control and awareness. "Most private practitioners are not even aware that TB is a notifiable disease." However, she admits that even the government does not reach out to private practitioners or convince them to enter the DOTS programme.

"Along with REACH, we are planning to tie up with one or two private hospitals in every zone to be part of DOTS and integrate with private hospitals and practitioners," Mr. Raja says. With the Indian Medical Association promising to involve itself in TB control, NGOs believe the much needed thrust to involve private practitioners will finally be provided. The IMA is in the process of putting together a national task force to involve the whole country, its representative, R.V.Asokan, says.

Printer friendly page  
Send this article to Friends by E-Mail