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India moves towards a national partnership to fight TB

25 Nov 2008

Bobby Ramakant

Source: TropIKA

A national multi-stakeholder partnership for TB care and control is being developed in India. Representatives from a range of TB stakeholder organizations recently participated in a day-long meeting at LRS Institute of Tuberculosis and Respiratory Diseases in New Delhi. The meeting was facilitated by the India Resource Centre of the International Union Against Tuberculosis and Lung Disease (IUATLD).

India ranks first in the list of 22 TB high burden countries globally with about 20% of the world’s cases. According to a WHO’s report – Anti Tuberculosis Drug Resistance in the World (2008) – India and China together have more than 50% of the world’s drug-resistant TB cases. India also figures high on the list of high-burden multi-drug resistant TB (MDR-TB) countries.

India has made major strides in TB care and control, testing more than 40 million people for TB and rolling out anti-TB treatment to more than nine million sputum-positive patients since 1997. Every month more than 100,000 patients are put on directly-observed treatment short-course (DOTS) treatment, with a cure rate in sputum-positive patients of over 85%, under the Revised National TB control Programme (RNTCP). However, drug-resistant TB is rising at an alarming rate.

‘Partnership in TB care and control is not new to India’, said Dr LS Chauhan, Deputy Director General (TB), Directorate General of Health Services, Ministry of Health and Family Welfare, adding that, ‘Since 1995, India has forged partnerships with different sectors to improve TB programme performances.’

‘Despite the involvement of more than 2,500 NGOs, private practitioners, 260 medical colleges and 110 corporate sector hospitals in the RNTCP, the contribution of the TB programme is not at the desired level’, said Dr Chauhan.

‘There is a need now for close coordination and clear communication while working together to face the challenge of including those who are currently outside the reach of the public health system’ said Dr Chauhan: ‘There is not enough coordination between different TB stakeholders at the district or state level, and no regular coordination at the national level.’

According to Dr Chauhan, ‘The RNTCP programme cannot document every best practice or challenge faced at the grassroots in TB care and control, so other people need to take leadership and come forward.’ The voices of frontline workers in TB care and control need to be heard in order to inform the policy makers.

Recent reports have identified theprogrammatic challenges impeding TB responses in India. They include: limited community awareness; sub-optimal community participation and sense of ownership; the emerging challenges of TB-HIV co-infection and drug-resistant-TB management; and limited access to quality TB care for hard-to-reach, marginalized and vulnerable populations.

‘Eight million new TB cases are diagnosed every year and two TB deaths take place every three minutes in India’, said Professor (Dr) D Behera, Director, LRS Institute of Tuberculosis and Respiratory Diseases, New Delhi. ‘Just providing anti-TB treatment is not sufficient, treatment is interrupted due to poverty, unemployment etc.’ added Dr Behera.

‘The way to do business’

‘At USAID, partnerships are the way to do business. Partnerships enhance efficiency and effectiveness, rationalize division of labour and maximize synergy’, said Robin Mardeusz from the United States Agency for International Development (USAID). He highlighted one of the major benefits of the partnerships in providing multi-action innovative solutions. USAID has supported the secretariat of the national partnership for TB care and control to be hosted by IUATLD through a World Vision grant.

Another civil society partnership on TB, launched last year to complement India’s RNTCP, is the NGO TB Consortium which includes eight major civil society organizations contributing to TB care and control: the Adventist Development Relief Agency, Damien Foundation India Trust, German Leprosy and TB Relief Association, LEPRA Society, PATH India, Project Concern International India, TB Alert India and World Vision India.

One clear mandate of an effective and genuine partnership for TB care and control would be to help strengthen the mechanisms for equitable access to information and meaningful participation, particularly for those undergoing anti-TB treatment, those who have successfully completed their anti-TB treatment, or those who are at increased risk of TB including people living with HIV. Without documenting the voices of the affected communities – so that the best practices and challenges inform TB programmes in order to improve performance – experts fear that India will fail to achieve its targets for TB prevention, treatment and care.

Another major mandate for such a partnership would be to scale up communications and advocacy to implement the Patients’ Charter for Tuberculosis Care, so that affected communities can use the Charter to raise awareness and consciousness about the rights and responsibilities of people with TB, to strive towards achieving International Standards for Tuberculosis Care across the country.

How well the TB Consortium will complement the National Partnership for TB Care and Control is yet to be seen. Daunting challenges lie ahead but the coming together of stakeholder organizations and communities is an encouraging development.

The author, Bobby Ramakant, is a member of HDN Key Correspondent team and a World Health Organization (WHO)’s WNTD Awardee 2008. He can be contacted at: bobbyramakant@yahoo.com).