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Cut in healthcare budget hits India's war on Tuberculosis

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  • Cut in healthcare budget hits India's war on Tuberculosis

    Cut in healthcare budget hits India's war on TB
    Rupali Mukherjee, TNN | Jul 9, 2015, 03.29AM IST

    India has the highest burden of TB with two million cases every year, with over 60,000 drug-resistant TB patients. (Representative image)
    MUMBAI: After a slash in India's healthcare budget and key public health initiatives, now the country's ambitious tuberculosis control programme is facing a serious challenge, which could jeopardise supply of medicines, and lead to inadequate diagnostic services for TB patients.

    The proposed funding cuts in the country's TB control programme could lead to serious consequences like stock-outs of key TB medicines, and inadequate or shortage of specialised diagnostic kits, leaving patients in the lurch, and, in certain cases, to either face a relapse of the disease, or lead them to the dreaded drug-resistant form.
    According to the Central TB Division, India has the highest burden of TB with two million cases every year, with over 60,000 drug-resistant TB patients.

    Worse, the expansion of resources planned under the NSP which would triple the expenditure of the prior plan, has not been matched by allocation. While RNTCP expenditure has increased 27% since 2012, there is a growing gap between the allocation of funds and the minimum investment required to reach the goals of the Plan.

    Funding crunch affects India's fight against TB: report
    India's program to fight tuberculosis is in disarray due to a shortage of funds and the government has failed to meet annual targets to control spread of the nation's most fatal infectious illness, a leaked assessment report said.

    India records more than 300,000 tuberculosis-related deaths and 2.2 million new cases of TB each year, resulting in an economic loss of $23 billion, the government says.

    The report was drafted by several experts including those from the government's TB division and the World Health Organization. The draft is not in the public domain but was leaked on the Internet by health activists late on Wednesday.

    Published Date: 2015-07-11 10:01:25
    Subject: PRO/EDR> Tuberculosis - India (03): national TB control program assessed
    Archive Number: 20150711.3502593
    ************************************************** *************
    A ProMED-mail post
    ProMED-mail is a program of the
    International Society for Infectious Diseases

    Date: Thu 9 Jul 2015
    Source: [edited]

    A report assessing the country's TB programme stops just short of saying that it has been derailed. A million tuberculosis cases in India have escaped detection, says leaked report.

    The latest assessment of India's National Tuberculosis policy has noted that nearly 10 lakh cases [a lakh is a unit in the Indian numbering system equal to 100 000] of people living with tuberculosis in India have either gone undiagnosed or unreported. More worrying is the fact that for nearly 2 years, the TB programme has suffered "unaccountable delays" in the procurement of medicines. The programme is also "not detecting as many cases" as expected, and many planned activities are not being implemented.

    The report has been prepared as part of the Joint Monitoring Mission of the Revised National Tuberculosis Control Programme. The Mission brings together national and international experts, the Ministry of Health and developmental agencies to "review the progress, challenges and plans for India's TB control efforts". Other concerns in the leaked report are focused on the National Strategic Plan for 2012-2017, which it says is "not on track".

    Each year, the health authorities are notified about 12 lakh Indians with newly diagnosed TB. At least 2.7 lakh Indian citizens die from the disease. "Some estimates calculate deaths twice as high," noted the Joint Monitoring Mission report. According to the World Health Organization, India had more than 2 million TB cases in 2013, the highest number in the world, and about 1/4 of the global cases.

    In the past decade, India's TB programme has attracted global attention for reaching the largest number of affected people. More than 80 million people have been tested, 15 million TB patients detected and treated.

    Another hallmark for the Indian TB programmes was achieving complete geographical coverage for diagnostic and treatment services for multidrug resistant TB in 2014. Over the last 3 years, a remarkable 66 000 patients have been diagnosed and put on treatment. The nation's 1st national anti-TB drug resistance survey is being conducted by the National Tuberculosis Institute in Bangalore.

    But the praise for the programme stops with that. According to the leaked report, the authorities have not been notified about nearly 10 lakh Indians living with TB. "Again, this could be even higher," says the report. "Surveys have shown that many people with TB remain in the community, untreated. Yet case reporting has gently declined since 2009. MDR [multidrug resistant] TB is emerging as a massive organisational and financial challenge to the RNTCP [Revised National Tuberculosis Control Programme]."

    The failure to notify new TB patients, according to the leaked report, lies with India's unregulated private hospitals. "Two decades of attempts to improve collaboration between the public and private sectors, have not yet worked," says the report. "The existing TB surveillance system lacks the capacity to count the large pool of privately diagnosed and treated TB cases, and what is not measured is unlikely to be improved."

    The leaked draft has the health minister JP Nadda quoted as agreeing "that his [sic] Ministry had to take initiatives with the private sector to avoid further increases in drug resistance".

    The report puts the economic burden of TB to the Indian economy between 2006 and 2014 at a staggering USD 340 billion. "The average cost to a family of any member with TB can amount to as much as 39 per cent of annual household expenditure -- a catastrophe for any family already impoverished," states the report.

    Further, the report's most significant concern is the lack of funds for the expansion of the programme. As it stands now, the health ministry's ambitious expansion of the TB programme planned under the National Strategic Plan 2012-2017 would triple the expenditure of the prior plan. But allocations have not matched the government's policy vision.

    "While RNTCP [Revised National Tuberculosis Control Programme] expenditure has increased 27 per cent since 2012, there is a growing gap between the allocation of funds and the minimum investment required to reach the goals of the plan," says the report. "If this trend continues, final expenditure on the plan would reduce to Rs. 3000 crores [crore is a unit in Indian numerical system which is equivalent to 10 million; one crore Rupees is same as 10 million Rupees; 3000 crore Rupees is about USD 473 million], or 2/3 of the minimum required. While the expansion of treatment of MDR [multi-drug resistant] TB cases is a major achievement, the cost of providing services is approaching 40 per cent of total RNTCP expenditure. This threatens the future of TB control in India and underscores the necessity to prevent drug resistance."

    The report strongly recommends that the government "significantly increases funding for TB control ... allowing RNTCP to spend Rs. 1500 crores [about USD 237 million] per year to achieve the goals of the plan." It says that additional investment of at least Rs 750 crores [about USD 118 million] annually will be required to reach the ambitious goals of the "End TB" strategy. This will save around 2.5 lakh lives every year. "In addition, every rupee invested in TB control will have a 100-fold economic return on investment," the report says.

    [byline: Vidya Krishnan]


    [WHO has published tuberculosis (TB) data for the year 2013 in the "WHO Global TB Report, 2014", which is available at The prevalence of TB in India has declined steadily since about the year 2000 from 400-500 cases per 100 000 population in the 1990s to 211 per 100 000 in 2013; the annual incidence remained over 200 cases per 100 000 until the year 2005, when it began to fall; it was 171 per 100 000 in 2013. However, the diagnosis was confirmed bacteriologically in only 68 per cent of new pulmonary TB cases; the rest were diagnosed clinically, probably because of the lack of laboratory facilities.

    WHO reports that India, with a population of 1.27 billion, has only 12 700 labs (1 laboratory per 100 000 population) capable of diagnosis of TB by acid-fast staining of a specimen (for example, sputum smear). Only 51 labs (0.2 labs per 5 million population) are capable of diagnosing TB by culture or are capable of drug susceptibility testing; and only 54 labs in India are capable of rapid diagnosis of multidrug resistant TB (MDR-TB). WHO reports that 2.2 per cent of new TB cases and 15 per cent of retreated TB cases were diagnosed with MDR-TB. If all TB patients had been tested for drug resistance in 2013, many more cases of MDR-TB likely would have been detected. 5 per cent of TB cases tested were found to be co-infected with HIV in 2013.

    For discussions of TB and MDR-TB in India, please see my comments in prior ProMED-mail posts listed below.
    Last edited by sharon sanders; November 8th, 2015, 07:36 PM. Reason: format
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

  • #2
    See also: India slashes health budget, already one of the world's lowest
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.