Good news on TB: A million lives saved

Prem Neelkanth runs a food stall in a sprawling Mumbai slum but he also dispenses medicines to many patients there, so do the 12 women volunteers in Motinala slum of Jabalpur in Madhya Pradesh.

Prem Neelkanth runs a food stall in a sprawling Mumbai slum but he also dispenses medicines to many patients there, so do the 12 women volunteers in Motinala slum of Jabalpur in Madhya Pradesh.

All of them are Directly Observed Treatment System (DOTS) providers, ordinary people who are given the task of ensuring that TB patients take their medicines on time. Supported by an army of nearly 4 lakh DOTS providers, 2,000 NGOs, 10,000 private practitioners, 11,000 peripheral laboratories, over 200 medical colleges and more than 100 corporate health facilities, India has achieved what was considered impossible a couple of decades back. According to the TB Joint Monitoring Mission, more than a million deaths have been prevented since the DOTS was started in India in 1997.

India is implementing the largest TB control programme in the world, which provides treatment for an additional 100,000 patients every month, with a treatment success rate of 86 per cent.

In 2004, one-fifth of the total cases treated in the world were in India. By December 2005, more than 97 per cent of the country (1,080 million in 616 districts) had access to DOTS. In 2005 the coverage was increased by 133 million and 69 districts.

However, the Joint Mission has strongly recommended continuous support to the programme and involvement of cadres of National Rural Health Mission for improving access and sustainability. These observations were made by the group of 20 international experts and 20 representatives of stake-holders from India which reviewed the programme for nearly two weeks.

Over the last two weeks, members of the JMM visited 20 randomly selected districts in Gujarat, Haryana, Karnataka, Madhya Pradesh, Punjab and West Bengal. They interacted with national, state and district-level authorities, extensively reviewed patient records, and interviewed patients and the programme staff.

The Mission stated that the programme is very effective, including the microscopy services for diagnosis, reliable supplies of good quality drugs and a transparent and powerful reporting system.

“The programme has to be continued for two to three decades before the epidemiological results can be achieved,’’ said Dr L.S. Chauhan, director of the TB control programme in the country.

Story continues below this ad

The disease continues to affect about 1.8 million new people every year. Two of every five Indians are infected with the TB bacillus. Of them, 10 per cent will develop TB disease during their lifetime.The direct cost of the disease in India annually is estimated at $ 300 million and the indirect cost $ 3 billion.

Another important battle the programme is fighting is the multiple drug resistant TB, which comprises three per cent of the new cases. While treating a general patient costs about Rs 400-600, MDR TB treatment costs about Rs 1 lakh. “If it is not treated, a person could infect 10 to 15 persons a year,’’ said Chauhan.

The government is planning to provide free treatment to drug-resistant tuberclosis in government hospitals now. The project will first be started in Gujarat and Maharashtra where all those who are affected by the disease will be enrolled.

“By end of 2007, states like Tamil Nadu, Kerala, Andhra Pradesh and Karnataka will be covered. By 2008, we will be able to cover the entire country,” Chauhan said.

Story continues below this ad

The treatment module will be part of the Revised National TB Control Programme (RNTCP) based on the DOTS strategy.