Context:

Ministry of Health Family welfare’s Annual TB Report

Target of the government:

Ending the TB in India by 2025.

Highlights of the report:

• As per the report, 21.5 lakh TB cases were reported in the country in 2018 — the highest number of TB cases registered in any country.

1. 1. The report says that with the introduction of Nikshay, the computer-based surveillance programme for TB patients, the reporting of TB cases has improved dramatically.

• Data shows that more than 80 percent of healthcare is now being delivered by private health enterprises — something is evidently not right with the public health system.

• With a virtually unregulated private health system, an increase in notification of TB patients could be bad for the public health system.

• The number of HIV-infected people who go on to develop Tuberculosis (TB) is increasing in India.

1. According to the India TB Report 2019, the success rate of treatment of drug-resistant TB patients has remained stagnant at 47 per cent.

What is TB

• Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. 
• Tuberculosis commonly affects the lungs, but can also affect other parts of the body.
• It spreads from person to person through the air, when people who are infected with TB infection cough, sneeze or otherwise transmit respiratory fluids through the air. 
• Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to first-line anti-TB drugs. MDR-TB is treatable and curable by using second-line drugs.
• Extensively drug-resistant TB (XDR-TB) is a more serious form of MDR-TB caused by bacteria that do not respond to the most effective second-line anti-TB drugs, often leaving patients without any further treatment options.

Reasons for TB in India:

1. Hunger:  in global hunger index report, India’s rank is 102 out of 117 countries. Malnutrition and TB are directly related. Study by BMC Pulmonary Medicine journal from Ethiopia, the researchers clearly show that the proportion of malnutrition in TB patients was nearly 60 per cent. 
2. Sanitation: TB and sanitation have a direct causal relationship. The Integrated Disease Surveillance Programme run by the National Centre for Disease Control maintains a web portal that details the outbreak of epidemics. 
3. lack of civic-sense-people don’t think twice before spitting and coughing without covering their mouths-may be one of the reasons behind the spread of TB across all economic sections.
4. Poverty: TB is a disease of poverty. A lack of basic health services, poor nutrition and inadequate living conditions all contribute to the spread of TB and its impact upon the community. 
5. An unhealthy lifestyle, low immunity can cause TB in any person.

What are the steps taken by the government?

NI-KSHAY

NI-KSHAY-(Ni=End, Kshay=TB) is the web-enabled patient management system for TB control under the Revised National Tuberculosis Programme (RNTCP).

 Functions of NI-KSHAY

Nikshay is used by health functionaries at various levels across the country both in the public and private sector, 

• to register cases under their care, 
• order various types of tests from Labs across the country, 
• record treatment details,
•  monitor treatment adherence and to transfer cases between care providers. 
• It also functions as the National TB Surveillance System and enables reporting of various surveillance data to the Government of India.

National Strategic Plan (NSP) 2017 – 2025

 Targets

• • Private sector engagement
  • Plugging the “leak” from the TB care cascade (i.e. people with TB going missing from care);
  • Active case finding among key populations;

• and for people in “high risk” groups, preventing the development of active TB in people with latent TB.

TB Free India Campaign- The campaign aims to take activities of National Strategic Plan (NSP) for TB elimination forward in Mission mode.

Revised National Tuberculosis Control Programme (RNTCP), under this scheme the government has also proposed an incentive of Rs.500 per patient per month for the nutritional support of TB-affected patients during the course of the treatment.

Swachh Bharat mission– it aims to create awareness among citizens about the sanitation and its benefits both in terms of economic and social. Sanitation will improve the quality of air, water and food which directly reduces the incidences of TB.

Way forward

An end to TB is not possible till we end malnutrition, poverty and poor sanitation. We need a paradigm shift in response to TB. This should include a more sensitive approach on gender and towards the underprivileged.