We are commemorating the World TB Day on 24 March with a very important and timely message - ‘reach the missing three millions’.
India, with 26% of incident TB cases in the world, has one of the largest and well-run national TB control programmes in the world. Under the Revised National TB Control Programme (RNTCP), more than 16 million TB patients have been treated since its inception. The TB mortality and prevalence has also come down and the incidence is declining. Annually, 1.3 million incident TB cases are notified in the programme. However, out of the estimated three million incident TB cases missing from notification globally, nearly a million are from India. While the patients reaching the public health programme get quality assured diagnosis, treatment and public health support required for successful treatment outcomes, more than a third of the TB cases in the country are unable to avail these services. These missing cases could very well be amongst the most vulnerable groups, such as women, children, marginalized population, migrants, slum dwellers etc. Most of these missed cases might have been diagnosed and treated in other health care sectors, including the large private sector in India and these cases largely remain un-notified to the programme. This year’s slogan ‘Reach the missing three million’ gives us the opportunity to bring this particular challenge upfront and confront this reality.
The Government of India has taken some landmark policy decisions and developed key systems to address the challenges confronting the programme: ban of commercial serology for TB diagnosis, paving way for uptake of better diagnostic tools, including WHO approved rapid molecular diagnostics; making TB a nationally notifiable disease and developing an electronic case-based notification system-NIKSHAY; placing anti-TB drugs under a new schedule - Schedule H1 that makes it mandatory for chemists to keep the prescription and patient details. The programme has full geographic coverage for drug resistant TB diagnosis and treatment in the country. Intensified TB/HIV collaborative activities are now being implemented throughout the country.
Implementation of notification by all sectors is a vital step towards developing a better system for TB surveillance in India. We know that good surveillance system is a key component of any disease control programme. RNTCP has a good surveillance system, but only for those patients accessing its services. The new surveillance system should capture TB patient information from every sector and the effort should be for finding out all missing cases.
Coinciding with the World TB Day is the release of Standards for TB Care in India. These standards address India specific critical questions such as: What are the best strategies and tools for early diagnosis of all TB cases? What are the best ways to treat all TB cases, including drug resistant one’s and comorbidities? How best can the public health responsibilities be addressed across all sectors and the very important social inclusion standards for better patient care? The dissemination of Standards for TB Care is an important activity in 2014 for better engagement with all sectors for TB care in India. This will synergize the effect of notification and NIKSHAY to address the data gap about the mission of finding the missing one million cases in India over the next few years.
TB cannot be combated without strengthening the entire health system across all its components and goals, from financial protection to community engagement, and full integration of TB services in the regular health system. Equally, it is very important to maintain a high political and administrative commitment for TB care in the country.
Echoing the World TB Day theme, this year’s World TB day reminds us to focus on those missing million cases and implement strategies for early case detection of all TB cases, improved notification by all sectors and appropriate care for all.
Nata Menabde