Stumbling blocks in TB control

By Anita Joshua

NEW DELHI, FEB. 22. Even as the World Health Organisation gives fairly high scores to the Indian Government and medicos for effective administration of the Revised National Tuberculosis Control Programme (RNTCP), it is not so generous in its evaluation of the role of the media in generating awareness on the disease.

According to Dr. Thomas Frieden, a leading TB expert of the U.S. Centres for Disease Control and member of the team that recently reviewed the country's TB control programme, there was ``insufficient awareness of the importance of the programme and services being offered''. He identified this as one of the stumbling blocks in the implementation of the programme.

Tuberculosis now, in the view of Dr. Kraig Klaudit, senior adviser of the Advocacy Group of WHO, is not so much a technical or medical challenge as it is a political and management one. ``Strategies to battle TB, which consumes one life per minute in India, were evolved several decades ago and so the scientists have delivered. Now politicians need to put it high on their agenda and society should begin caring to battle TB in India, which has the maximum number of cases in the world.''

While lack of awareness is being seen as the weak link in RNTCP - which following a rapid expansion during the previous year has given India the second largest programme of this kind in the world - experts trace its roots to the fact that the disease affected the poorest of the poor, who are seldom heard.

The painful truth, experts maintain, is that the only time TB gets into focus is either in the eventuality of an epidemic or a sensational case. An oft-cited example is the way America woke up to the problem after a white prison guard in New York City died due to Multidrug-Resistant Tuberculosis, which to this day remains an incurable strain unlike TB which is 99 per cent curable.

Despite the ``almost miraculous expansion'' with phenomenal success of RNTCP, experts insist that there is no magic bullet to deal with the problem. If the media is held responsible for sidelining such ``soft issues'' unless there is a scandal, the community, too, is not absolved. ``If there is community pressure, the media will pay attention, and once an issue appears repeatedly in the media, politicians will sit up and take notice.''

Similarly, there is a view that the success of RNTCP - which uses a control strategy known as DOTS (Directly Observed Treatment, Short-course) - should be made aperformance indicator for districts/constituencies. Once a politician's fate hinges on the success of his/her constituency's ability to battle TB, then he/she is bound to find the will to address the problem, which costs the Indian economy more than Rs. 13,000 crores every year.

Further, Dr. Klaudit says, TB should be seen as a human rights issue and non-governmental organisations (NGOs) should take part in the national effort. Given the spread of TB - which cuts across every social class - having NGOs dedicated to addressing the problem is a near impossibility. ``But then TB can be on the agenda of an NGO working for children, women, HIV-affected persons or human rights. After all, 3,00,000 children leave school every year in India because a parent has TB,'' argues Dr. Klaudit.

Whatever the strategy chosen for generating awareness, the fact remains that time is at a premium. The WHO estimate is that the AIDS epidemic will push up TB cases by at least 2,00,000 each year in India. In the HIV age, India is faced with a race against time.

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