Meghalaya govt acts as 'Ni-kshay Mitra', 'adopts' all TB patients in state

Shillong: In an unprecedented initiative, the Meghalaya government has "adopted" about 4,500 tuberculosis patients in the state and has become a "universal Ni-kshay Mitra" for them as part of the 100-day Intensified TB-Mukt Bharat Abhiyaan.

The Centre launched the 'Ni-kshay Mitra' programme in September 2022, urging individuals, private organisations and civil society groups to "adopt" patients and provide them additional nutrition and diagnostic support.

Now, Meghalaya has gone a step further and become the universal Ni-kshay Mitra for all tuberculosis patients in the state.

Under its unique Comprehensive TB Care Initiative launched in December last year, the northeastern state has taken extra measures not just to improve treatment success rates but also to reduce morbidity and financial burden on the patients and their families.

In addition to the Rs 1,000 monthly nutritional support that each patient is provided under the Ni-kshay Poshan Yojana by the Union government, Meghalaya possibly is the only state that provides additional support worth Rs 2,000 per month to each patient in the form of a nutritional kit.

The kit comprises 10 kgs of rice, one tray of eggs, three kgs of moong daal, one litre of refined oil as well as seasonal fruits and vegetables to ensure a patient's faster recovery.

The aim is not just to provide nutritious food to the patient but also to take care of their family members so that their immunity is boosted and the future breakout of infection into active TB is prevented, said Ramkumar S, the mission director of the National Health Mission (NHM).

The state government also provides free transportation for TB patients and one attendant from their homes to the health facility and back, he said.

At the health facilities, patients are provided free-of-cost diagnostics with all additional laboratory tests and investigations completely taken care of by the state.

Besides, the Meghalaya government also provides skill development and vocational training to TB survivors so that they can earn a decent livelihood and return to normal life at the earliest.

Ramkumar S said studies have shown that with energy-dense, protein-rich nutrition, the chances of recovery for a tuberculosis patient are significantly high.

"That prompted us to approach TB patients in a different manner. We decided that patients, irrespective of which stage of the disease they are in, would be provided with a comprehensive nutrition kit every month.

"TB patients generally belong to underprivileged families suffering from poor nutrition and the chances of other members getting the disease are significantly high," he said.

The NHM mission director pointed out that it is difficult to find Ni-kshay Mitras in Meghalaya because of its geography and tough terrain.

"The population is dispersed among various hard-to-reach hilly areas where transportation is very difficult which makes service delivery and communication challenging," he said.

"The considerable spread of malnutrition because of lower per capita incomes coupled with behavioural issues such as chewing of tobacco and other substances are major challenges in tackling TB and other health issues," he elaborated.

Ramkumar S said that the Comprehensive TB Care Initiative was inspired by the tremendous success the state achieved in reducing maternal deaths by 50 per cent.

To tackle the challenge of high maternal mortality, the state began providing free transportation for pregnant women and set up transit homes where they could give birth and stay with their family members for a week to 10 days post-delivery. They are then transported back home.

They are also provided food and diagnostic support free of cost during the stay.

The state has also intensified TB testing, leading to a surge in presumptive TB examination, Ramkumar S said.

Back in 2015, as many as 845 people per lakh were being tested for TB. Fast forward to 2024, and that number has surged to 1,911 per lakh, ensuring more cases are detected early and treated before they escalate.

The diagnostics have also been ramped up, Ramkumar S stated.

The number of Nucleic Acid Amplification Test (NAAT) machines ”for TB testing has skyrocketed from just 29 in 2021 to an impressive 80 NAAT sites in 2024.

This expansion has dramatically improved early detection, ensuring that a remarkable 85 per cent of TB patients now receive an upfront NAAT test, Ramkumar S said.

The 100-day TB Elimination Campaign is being implemented in five districts -- East Khasi Hills, Ri Bhoi, East Garo Hills, West Garo Hills and South Garo Hills -- where the burden of the disease is on the higher side.

In 2024, the programme notified 4,573 tuberculosis cases in Meghalaya.

Since the launch of the campaign on December 7, as many as 867 patients have tested positive for tuberculosis. The TB death rate has been 5 to 6 per cent over the last four years and it has shown a decline recently, officials said.