Opinion - Editorials

The tuberculosis time bomb

NOWHERE ARE THE inadequacies confronting the Indian healthcare system more evident than in the decades-long fight against the killer disease, tuberculosis. That one life continues to be lost to the disease every minute, making India home to the world's largest number of tuberculosis patients, is a dubious distinction the country can do without. Estimates have it that half of the tuberculosis cases in the country are in the economically productive age group of 15-44. The importance of finding a workable solution to check the spread of tuberculosis has been reiterated through the recently concluded fourth World Tuberculosis Congress in Washington. In a way, assessing the outcome of the global fight against tuberculosis evades easy description. Though scientifically discovered more than a century ago, the world has but won small battles against the disease, which keeps developing new resistant forms. Changes in treatment methods and re-designed programmes notwithstanding, the bacillus continues to defy medical planners the world over. The Indian experience in tuberculosis control has two dimensions to it — research and treatment. While there has been a lot of Indian input in terms of research, leading to improvements in treatment the world over, the extent to which the nation has made use of these advances to make a dent on the spread of the disease in the country is still open to question.

One recent claim for success by the Indian health sector is the Revised National Tuberculosis Control Programme (RNTCP), which covers 221 districts across 21 States. While there could be cause for some legitimate pride for the public health authorities with the claim that the programme has averted more than 1.5 lakh deaths, for this approach to be truly successful it is important that a meaningful partnership is evolved between the public and the private health professionals. As the menace posed by tuberculosis is of a massive dimension, there will be no real success until the most important segment of the medical system — the private sector — is brought into the disease detection and control system. This, by itself, is a challenging task with its own set of contradictions. The private healthcare mechanism being a very varied group, ranging from private medical practitioners to polyclinics and medical testing laboratories, meaningfully determining who would be involved in the partnership against tuberculosis should be an important starting point. The effectiveness of the Directly Observed Treatment, Short-course (DOTS), which has a high success rate, is also dependent on the completion of the treatment. Though this gives rise to the hope that a cost-effective cure for the dreaded disease is available, the importance of completing the therapy needs to be emphasised to the patients.

The arguments for a greater public awareness cannot be emphasised in a more effective manner than the emergence of drug-resistant forms of tuberculosis, quite often a result of incomplete compliance by patients are under treatment. With all indications pointing to an alarming rise in the resistant form of tuberculosis, the crucial input is in spreading the awareness of the need to complete the treatment, irrespective of short-term improvements witnessed. An effective fight against tuberculosis will involve three important tasks — detection, therapy and compliance. With the inadequacies in the public healthcare system and the official acceptance that half the patients seek out the services of private health service providers, it is important that a coalition is formed against the disease by a coming together of those willing and able to carry the burden. Given the enormity of the task, identifying truly motivated medical practitioners and agencies with the relevant diagnostic equipment, the ability to maintain regular case histories and the willingness to relentlessly complete the task of providing cure is crucial. Success stories of community-based interventions from both within the country and other parts of the world need to be replicated if the battle against the centuries-old disease is to be truly won.

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