Treating TB: plan to reward private doctors

 With tuberculosis (TB) emerging as India’s biggest health threat, the Union health ministry plans to pay every private doctor who successfully treats a TB patient.

Prepared by the central TB division of the health ministry, the new TB control strategy aims to drastically bring down the number of TB cases and deaths by 2025.
India has an estimated 28 lakh TB patients, of which almost 10 lakh patients are “missing” from government records.

This means that the national TB control programme does not know if these 10 lakh patients are getting any treatment at all, and if they are, what the quality of the treatment is.

To track these missing cases, the strategy puts top priority on increased engagement with the private doctors — the first port of call for the majority of Indian patients. At least 50% TB patients in India are treated first by the private doctors.

For successfully treating a drug-responsive TB patient, the proposal asks to give a cash reward of up to Rs 2,750 to the private doctor. For treating a drug-resistant patient, the incentive can be up to Rs 6,750.

This includes Rs 250 for notifying the case to the government and Rs 250 every month till the successful completion of the treatment. A drug-responsive TB case may take seven to 10 months for treatment whereas the treatment of a drug-resistant TB patient can take up to two years.

In 2012, the government made it mandatory for private doctors to report the TB cases they treat to the government. Even though the initial response was lukewarm, the number of reportings rose in the last couple of years; even so, lakhs of cases are missing from the system.

“We know very little about private sector TB care. There is only one available study on TB treatment outcomes in the private sector, which showed that only about 50% of TB patients in the private sector complete the 6-month course prescribed in TB therapy. This is much lower than the 70%-80% treatment completion rate in the government sector,” Ramanath Subbaraman, a TB researcher from the Harvard Medical School in the US told DH.