Braving snow, rugged terrain and a pandemic, a dedicated team of health workers and consultants have been working tirelessly in the Himachal Pradesh to verify TB-free claims made by districts in the state. They are among hundreds of teams working in 74 identified districts across the country to verify TB-free claims before districts can be certified free of the disease.
In 2019, 2 640 000 people fell ill with TB in India, and 445 000 succumbed to it, according to the WHO Global TB Report 2020. TB treatment coverage in the country was 82% in 2019, against the End TB operational target of 90%.
Even the pandemic, which suspended activity between late March and October, could not dampen the commitment of these health care workers who, along with WHO consultants, medical college representatives and district health staff, renewed efforts in December to become the engines driving India’s Jan Andolan, or people’s movement, to End TB by 2025.
This is part of the nationwide efforts by the Ministry of Health and Family Welfare and the National TB Elimination Programme (NTEP) to find, test and treat more and more TB cases by actively collaborating with partners, private sector, patients and communities to measure progress and identify gaps for course correction.
The progress in reductions in TB incidence across states and within states varies widely, with some districts achieving greater declines in incidence than others. The Indian Council of Medical Research is leading the certification process and WCO India is supporting the first round for 74 districts in collaboration with community medicine faculty of medical colleges through the Indian Association of Preventive and Social Medicine (IAPSM) and WHO consultants.
“Measuring and documenting this decline at the district level serves the dual purpose of recording successes to encourage local authorities to sustain progress, and guide districts that are lagging with solutions to meet their elimination goals. This colossal effort will contribute to generating newer evidence for TB burden estimation and keep India on the track to elimination,” said Dr Roderico H Ofrin, WHO Country Representative to India.
Several states have applied to the Government of India for TB-free certification under the subnational certification of TB elimination efforts.
The NTEP has incentivized progress at various elimination milestones to motivate districts, states and UTs to achieve targets that are within their capacity and control. Districts are awarded medals, cash awards and felicitated nationally for substantial reductions in the TB incidence rate as compared to the 2015 levels.
Along with felicitation at the national level, districts that register a 20% decline win Rs 200 000 and a Bronze medal, those with 40% reductions receive Rs 300 000 and a Silver medal, Rs 500 000 and a Gold medal are awarded for 60% reduction, and Rs 1 million and TB Free certification are awarded for an 80% or more decline as compared to baseline of the year 2015. WHO TB consultants have supported house-to-house surveys, verification of secondary data on programme performance, and undertaken key informant interviews and focus group discussions with several stakeholders. The districts with verified claims were awarded on World TB Day on 24 March 2021.
In addition to providing high-end technical support, TB consultants are advocating with other regional stakeholders to encourage them to apply for a TB-free status.
WCO is supporting India’s efforts to measure TB incidence at the district level by providing technical assistance for developing the scientific protocols, coordinating with all verification agencies at multiple levels (national, state and district), developing training materials and capacity building of survey and verification teams, and designing and developing data-collection tools. Apart from that, WHO will assist in the supervision, monitoring, analysis and interpretation of data.
This unique initiative of subnational certification of TB elimination efforts being conducted across India will encourage several other regions to come forward and collectively End TB.
“This Jan Andolan is unstoppable because of the colossal efforts of officers in the ministry and programme division, partners, State officials, District Collectors, Health Officers and ASHAs -- who are the frontline warriors -- who have made this possible through their sustained efforts to end TB,” said Dr Ofrin.