Later this month, health ministers of our governments will convene for World Health Assembly (WHA) to shape the agenda of the World Health Organization (WHO) as well as elect its new leader as Dr Margaret Chan's tenure as WHO Director-General comes to an end. During Dr Chan's leadership of WHO, adoption of the WHO End TB Strategy in WHA 2014 and world leaders coming together to address antimicrobial resistance (AMR) at UN General Assembly 2016, are among the key milestone moments.
Governments' committing to end TB by 2030 (as per the promises made in the Sustainable Development Goals or SDGs and WHO End TB Strategy) is indeed welcome but not enough as current rate of TB decline is a fraction of the required rate of TB decline for ending TB by 2030.
Mark A White, Mission Director of US Agency for International Development (USAID) in India shared an old wisdom: "If you do what you did, you will get what you got" calling for innovations to help us collectively meet the promises for ending TB. Mark was among the key speakers at the TB Free India Summit organized in Dharamshala, Kangra, in Himachal Pradesh, India. This innovative event brought together film stars, parliamentarians, private sector representatives, TB survivors, public health experts, media, and a range of other stakeholders. This event also leveraged upon popular game of cricket to amplify key TB messages.
Keeping workforce healthy is smart business sense!
Learning lessons where public health interventions gave better outcomes is a smart thing to do. Evidence shows that both public health and business interests are served better if mining industries prioritise health of their workforces. Jose Luis Castro, Executive Director of the International Union Against TB and Lung Disease (The Union) said that TB often affects people in the most economically productive years. "When workers get sick then companies suffer, and families suffer. Just like we have seen in the mining companies in South Africa, that are starting to initiate programmes to protect health of their workforces, we need India's corporate sector to help workforces to protect themselves. I urge you to consider workplace programmes to help prevent TB. It’s possible that you may even see this as another form of value investment because you may have better staff retention and higher productivity."
“Keeping workforce healthy is not only central to social justice and equity, but also makes a smart business sense!” said Shobha Shukla, Executive Director of CNS (Citizen News Service).
Innovations plugging gaps in Kangra
Dr Rajesh K Sood, District TB Officer of Kangra district where TB Free India Summit was held, shared innovative ways he has engaged different sectors to improve TB programme outcomes on the ground. In 2014, when supply-chain issues had temporarily crippled the MDR-TB programme with some drugs going out of stock, he reached out to local philanthropists and citizens networks, via social media channels, appealing them to come forward with help so that patients can continue with uninterrupted supply of quality-assured medicines for MDR-TB. Drug stock-outs propel drug resistance as well as increases the risk of treatment failure, even death. “Within minutes we were flooded with calls offering help. This led to formation of a 'medicine bank' with donations in kind which helped patients to complete treatment and reduce their out of pocket expense on health” said Dr RK Sood.
Another group of citizens donated water campers for DOTS centres. Patients need to take their TB medicines with water which was available at a distance from the DOTS centres. So installing these water campers at the DOTS centres made it convenient for the patients, said Dr RK Sood.
Dr Sood's team successfully engaged a bank in TB control too. Yes Bank helped the fight against TB in Kangra by raising awareness on cough hygiene. Posters on cough hygiene and sputum microscopy related messages were displayed by the bank in every designated microscopy centres (DMCs) and other public places in remote areas. These posters also have information about TB testing facilities at various DMCs.
Those who were sadly orphaned or widowed due to TB were identified in Kangra and nutritional support provided to these families with support from Rotary Club Palampur. Nutrition plays a key role not only during TB treatment but also in helping prevent development of active TB disease. The staple cereals grown in local farms or available via public distribution system of government were not included rather this nutritional support provided items like pulses, condiments and spices, cooking oils among others, informed Dr RK Sood.
GAIL India is country’s largest natural gas company with corporate social responsibility (CSR) budget of INR 810 million (INR 81 crores) for 2016-2017. GAIL India runs a mobile medical clinic which also provides TB services in Pata, a site of its major petrochemical plant. This van has medical doctors including pathologists, and people to raise awareness. It will soon get equipped with a Gene Xpert machine too (molecular diagnostics for TB which reliably tells within 100 minutes whether a person has TB and if the person is resistant to Rifampicin) said GAIL's representative.
Delhi Metro Rail Corporation (DMRC) was represented by PK Pathak, Deputy General Manager (DGM) for Operations. DMRC carries almost 2 million people daily across Delhi and neighbouring parts of national capital region. Sensing the potential of how DMRC staff members can help bolster TB awareness among their family members and wider communities, DMRC partnered with the International Union Against TB and Lung Disease (The Union) to organize sessions at its own DMRC Training Institute for raising awareness among staff on TB.
Infrastructure Leasing & Financial Services Limited (IL&FS) is an Indian infrastructure development and finance company. Its representative promised to consider integrating TB component in their community interventions around the road development projects. Moradabad-Bareilly highway and Bilaspur, are some of the sites where they are actively considering adding TB programming as a part of their interventions for local communities. It has earlier been supported by the Global Fund to fight AIDS, TB and Malaria (The Global Fund) for HIV and migrant populations related interventions.
Malnutrition defeats TB prevention, control and care in several ways. Undoubtedly to make TB prevention, control and care successful, nutrition is of essence. Recognizing this gap, Johnson and Johnson chipped in and provided nutritional support to over 3700 TB patients in Maharashtra. It has also contributed to diagnosing TB in over 5000 patients in Maharashtra.
But this is not all: Johnson and Johnson is perhaps best recognized for its role in research, development and launch of Bedaquiline: one of the two anti-TB drugs that got added to our arsenal in last forty years. Before 2016 World TB Day, Johnson and Johnson had sponsored 600 courses of Bedaquiline for Government of India to be given to needy patients from six centres across the country under controlled-access programme. Johnson and Johnson also runs a compassionate use programme in private sector for patients who might need Bedaquiline.
In partnership with the Government of India, Johnson and Johnson has adopted Gaya district to reinforce its TB programme with four mobile vans equipped with Gene Xpert machines (molecular diagnostics for detecting TB and Rifampicin resistance within 100 minutes). It also supports uninterrupted supply of cartridges for these machines.
More significantly, Johnson and Johnson promised to consider partnering with Himachal Pradesh state government to strengthen the drug-resistant TB interventions as well as state-wide efforts to eliminate TB by 2021-2022. Earlier in TB Free India Summit, Himachal Pradesh State Minister for Health and Family Welfare Kaul Singh Thakur had announced that TB will get eliminated from the state by 2021-2022, few years before India’s commitment to eliminate TB by 2025.
Dr Bornali Datta, senior Respiratory and Sleep Medicine expert at the Medanta - The Medicity, shared how Medanta is supporting TB free Haryana campaign and might also double up to do the same to make Himachal Pradesh TB free by 2021-2022. Medanta runs vans across the state which are equipped with TB diagnostics as well as has experts onboard, in order to reach the unreached populations with a wide array of TB services.
Dr Reddy’s Lab is doing TB test for every employee and is considering extending this service to over 150,000 (1.5 lakhs) migrant workers. It is also exploring effective ways to transfer sputum samples as well as reinforce TB programmes with nutritional support.
Shireen Mistry shared that Tata Trust has been a key part of two innovative interventions in India: India Health Fund and TB Research Consortium. India Health Fund is a unique platform launched in 2016 in collaboration with the Global Fund to fight AIDS, TB and Malaria (The Global Fund) and aims to target two major public health challenges in India (TB and malaria) by leveraging resources from private sector. They are also looking at effective ways to improve surveillance and other initiatives that can have a multiplier effect in terms of public health impact. The TB Research Consortium launched last year with Indian Council of Medical Research (ICMR) focusses on accelerating TB research in India for better diagnostics.
Together we win...
There is no doubt that ministries of health have a pivotal role in the fight against TB but unless all actors beyond the ministries of health can fully contribute to this well-coordinated #endTB mission, we will fail to meet the SDGs. Private sector is certainly among the broad range of actors that ministries of health need to engage with, along with affected communities, all parliamentarians, celebrities, faith leaders, public health experts, researchers, among others. The WHO End TB Strategy also recognizes the role of private sector. Air-borne diseases that can infect everyone, must also unite us all to win this fight. We have promises to keep and a long way ahead to end TB!
(Bobby Ramakant serves as the Policy and Communications Director at CNS (Citizen News Service). He was awarded the WHO Director-General's WNTD Award 2008. Follow him on Twitter @bobbyramakant)