India has made impressive gains in the fight against tuberculosis (TB) but significant challenges still confront us in the path ahead to eliminate TB. The launch of 'Call To Action For A TB Free India' by Sri Jagat Prakash Nadda, Minister of Health and Family Welfare, Government of India, in Delhi on 23rd April 2015, is aimed to catalyse progress towards ending TB in India. "This TB Free India campaign aims to unite existing and new stakeholders in the fight against TB and bring together our knowledge, resources and capacity to better equip us to beat TB" said Dr KS Sachdeva, Additional Director General, Central TB Division, Ministry of Health and Family Welfare (MoHFW), Government of India.
Silver lining: Progress in fight against TB
"We have cured almost 2 crore [20 million] patients from TB and 32 lakhs [3.2 million] lives have been saved – this is not a small achievement by any account. But if we look at the task which is still unfinished that is also extremely significant. We still have almost 10 lakhs [1 million] patients who are yet not under our fold. A very close monitoring is required – not just of the Revised National TB Control Programme (RNTCP) but also of the private sector to ensure that TB cases are being diagnosed and treated as per the standards of TB care and guidelines" said Bhanu Pratap Sharma, Secretary Health, MoHFW of India.
Since the implementation of RNTCP, India has made more wins in its fight against TB: Services for drug-resistant TB and TB-HIV collaborative care have been scaled up and made available across the country; 70,000 MDR-TB patients and 2000 XDR-TB patients have been put on the standard treatment; Standards of TB Care in India have been developed, aligning diagnostic and treatment practices across all stakeholders; NIKSHAY – a real time case based, web-based TB surveillance system has been rolled out; the first ever and largest national drug resistance survey is already underway, among other things in India.
As momentum picks up, steep climb ahead
Jagat Prakash Nadda, Minister of Health and Family Welfare said: “We must reach all patients, diagnose them early and provide them with correct and full treatment. We will do whatever is necessary to achieve our goals [envisioned in the Call to Action for TB Free India]. Resources will not be a problem or a constraint. More important we will focus on innovation which is required in our approach for universal coverage for TB. We will use mobile and telecommunication technology to provide a platform where people can call us on a toll-free number seeking help and guidance. Even a missed call will suffice. Our team will revert back and ensure that the person is covered by the programme and gets free accurate diagnosis and right treatment.”
Nadda reiterated the commitment that MoHFW “Will ensure:
- 90% of coverage of BCG is achieved under mission ‘Indradhanush’;
- We reach the unreached – our aim is to diagnose all TB cases and refer them to nearest public health centre. For this purpose extensive use of point-of-care diagnostic kits will help achieve screening;
- Treatment completion is satisfactory – and matches international cure rates of MDR-TB and XDR-TB;
- To encourage research for new drugs and new drug regimens, in order to achieve better regimens and in short durations;
- To promote indigenous development and manufacture of diagnostic tests under ‘Make In India’ programme
- There are provisions of comprehensive healthcare for TB patients and we will work out schemes and sensitise patients to help complete treatment. We need to link them with various welfare schemes of government of India so that the earnings of these families increase and that they have nutritional support which will enhance the immunity status of each member of the family.”
Sense of urgency
"We need to communicate the sense of urgency to eliminate TB from India, and for that matter, from the world. Tuberculosis is a disease that requires urgent action – people are dying, families are being destroyed, economies of countries are being crippled, national security of nations is affected by tuberculosis. New challenges have made the fight against TB even more difficult: anti-TB drug resistance, 2-3 times higher TB risk for people with diabetes, rising tobacco use which is a common risk factor for TB and other non-communicable diseases (NCDs) as well. People with diabetes have 2-3 times higher risk to get TB, tobacco use is a risk for TB, even those who get cured from TB and continue to use tobacco are twice as likely to get TB again. TB requires urgent action. Let everyone know in India that ending TB is an urgency” said Jose Luis Castro, Executive Director, International Union Against Tuberculosis and Lung Disease (The Union).
Partnership is key: No one can do it alone!
"TB Free India is a call to action, it is a shared vision and commitment. It is not just a commitment of government of India, it is a vision of various other stakeholders such as doctors, civil society, corporates, private sector, international agencies, nongovernmental organizations, among others. Government cannot do it alone. Under the umbrella of RNTCP we have formed a task force for call to action for TB free India. The United States Agency for International Development (USAID) has committed USD 4.6 million funding for this initiative, International Union Against Tuberculosis and Lung Disease (The Union) will be its secretariat, and MoHFW will lead the task force with the WHO as its technical partner" shared Anshu Prakash, Joint Secretary, Ministry of Health and Family Welfare, Government of India.
Anshu Prakash underlined the three pillars of the Call To Action For TB Free India: “First pillar is advocacy – for all sectors to get those patients (who are not in the programme) under the programme; second pillar is an effective media and communication campaign – this money will not be used to buy media space as government does that already, but to make an effective media campaign for TV, radio, print media, social media etc; and third pillar is to reach the corporates and private sector as it is important to involve them in this initiative."
Conviction to end TB is global
We may recollect that almost a year ago in May 2014, the World Health Assembly had approved a significant milestone for ending TB: the post-2015 End TB Strategy of the WHO. Dr Mario Raviglione, Director of WHO’s Global Tuberculosis Programme, said: “India and other countries need to accelerate the decline in TB incidence and help to achieve our milestones for 2025 and the targets for 2035 for ending the TB epidemic. End TB Strategy is based upon 3 pillars too: (i) integrated, patient-centred care and prevention; (ii) bold policies and supportive systems; and (iii) intensified research and innovation.”
Dr Raviglione added: “The emphasis under the first pillar is upon early case detection, community involvement to ensure treatment completion, and prophylaxis for treatment of latent TB. We need to get all the possible best levels of standards of care for all TB patients which includes: rapid accurate diagnosis, doing what is needed to treat, and support every single person who is affected by tuberculosis in this country, and globally. Second pillar of the strategy is about being bold in policies – there are policies that needs to be implemented fully in India and everywhere in the world. Policies for universal coverage which translates into free diagnosis and treatment for the poorest of the poor which are the ones affected by TB –talks about social protection mechanisms. Third pillar is the research and India is the one of the countries with widest possible capacities to do research in the world."
Financing progress to end TB is critical
“We need to find innovative ways to increase domestic funding to ensure progress towards implementing the Call to Action for TB Free India is well-resourced too” said Jamhoih Tonsing, Regional Director, International Union Against Tuberculosis and Lung Disease (The Union). “We also need to look at non-technical solutions to find answers for how can we increase visibility of TB. We need to find ways to get more earned media coverage on TB related issues.”
Agreed Bhanu Pratap Sharma, Health Secretary, MoHFW of India: “One challenge [in implementing Call To Action] will be to ensure that there is enough funding – we need to see that the programme is adequately financed.”
Time to act is now!
“We have set very ambitious targets for ending TB by 2035 globally. The first five years between now and 2020 are extremely important and we are looking at India with lot of hope – to show the world that it is possible to move the agenda forward and accelerate the progress towards ending TB. We have to go from a project that shows extremely great results to a bigger scale with a bigger speed” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership.
“No call to action can ever succeed if we do not exactly know what needs to be done. And to know what exactly needs to be done is not only about reading a textbook but also about going to the fields and understanding where the real ground-problems lie, what the issues are, and this is what has preceded the launch of the call to action in the form of Joint Monitoring Mission (JMM) organized by the Government of India and the WHO. On the basis of these critical findings and assessments we can pull our strengths and knowledge and request India to move forward in implementing them” shared Nata Menabde who represents the WHO in India.
“We are going to achieve 100% case diagnosis and 100% treatment of these. We cannot afford to miss a single case of TB. We will deploy diagnostic tools such as molecular tests to accurately diagnose every case of TB. Call for TB Free India needs to reach every state and further percolate to every level” rightly said Dr Jagdish Prasad, Director-General Health Services, MoHFW of India.