Little effort from private sector to fight TB

More than two years after tuberculosis was made a notifiable disease, lukewarm response from the private sector turns out to be a big challenge even as the disease claims almost three lakh people each year.

India has the world’s highest number of TB cases (close to 20 lakh) and the disease kills 1,000 Indians daily.

Because of the high disease burden, the health ministry made it a notifiable disease in May 2012, hoping private doctors, hospitals and pathology laboratories receiving TB patients would report those cases to the government-run TB control programme.
The move was expected to find out new drug resistant cases, emerging as the major public health threat. Unfortunately, this has not happened.

In 2012, private practitioners reported 2,842 cases to the government whereas private hospitals and diagnostic laboratories reported only 132 cases each to the government, sources told Deccan Herald.

The health ministry went for a campaign to inform private doctors and hospitals. The numbers show improvement in 2013 with general practitioners referring 17,535 cases to the government.

In addition, private hospitals reported 19,631 cases to the government whereas the diagnostic laboratories referred to 1,430 cases in 2013. But the numbers, sources said, were still too low when viewed against the backdrop of India’s population and a huge TB load.

“The government merely wants to know the number to fine tune its public health strategy. We don’t want to take over the practice of private doctors, who should not fear the government,” said a health ministry official, associated with the TB control programme.

Multi-drug resistant tuberculosis is spreading its tentacles. India has one of the world’s highest number of MDR TB patients, who are missed out in the national screening system and are not on the treatment. India had an estimated 64,000 MDR cases in 2012, majority of them are either without diagnosis and were not put on the treatment, crippling the fight against TB.

A large number of drug resistant TB cases happened because patients visited many private practitioners who either gave inappropriate prescriptions or the patients did not complete their treatments. Many a time, laboratory tests too are wrong.

India currently has 55 laboratories, which offer WHO approved four latest diagnostic tests. But many of them are too expensive for a large section of patients. “The common sputum smear test is at least 10 times cheaper but the test has poor sensitivity,” said Madhukar Pai, a TB researcher at McGill University in Canada.

Following the WHO advice to stop blood tests for TB, the health ministry in June 2012, banned their use as they were highly inaccurate and provided misleading results.