The Indian state of Uttar Pradesh (UP) has close to 20% of patients with active TB disease in India. According to the recent TB report published by the Revised National TB Control Programme (RNTCP), 277,245 patients were registered in one year (2010) for TB Treatment in UP out of 15,22,147 total new TB cases in entire country (source: RNTCP report, December 2011). According to the drug surveillance reports, UP state might have up to 17% of these TB patients as drug-resistant. With drug susceptibility testing (DST) services available in only few cities (such as Agra and Lucknow) and alarming levels of other risk factors such as high tobacco use, malnutrition, weak health systems, irrational use of drugs, and diabetes to name a few, UP might be in for a serious battle ahead with TB and drug-resistant TB.
The day when monsoons hit the parched lands of UP, more than fifty people from different districts of UP braved the rains to come to a civil society meeting hosted by the Partnership for TB Care and Control in India, with support from Project Axshya (funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) Round 9 grant to the International Union Against Tuberculosis and Lung Disease (The Union) South East Asia office). Participants included representatives from different NGOs, partners of the Partnership for TB Care and Control and TB Forum in UP.
Participants from different districts of UP raised key challenges in TB control in their local contexts. They also highlighted on what’s working and what’s not. The meeting came up with a memorandum to be submitted to the Government of UP which captures the issues raised in this meet to improve TB programme outcomes in the state, said Subrat Mohanty, Project Coordinator, Programme Management Unit, Project Axshya, The Union, South East Asia office.
The memorandum addresses the following issues:
According to RNTCP 2011 report, there are 1941 lab technicians in UP. Lab technician is the back bone of RNTCP. She plays crucial role in diagnosing TB cases. Available data shows that approximately half of the total sanction posts of lab technicians are lying vacant. Many of them who are in place are not available during their duty hours and do not pay proper attention towards patients’ problems. Therefore, all the vacant posts should be filled up immediately to save the life of TB patients, provide them with accurate diagnosis and standard treatment and care, and sensitize lab technicians enough to ensure patient friendly services.
SUPERVISION OF RNTCP STAFF
The success of RNTCP depends upon efficient supervision of existing staff. But it has been observed that in many places supervisory staffs at RNTCP are not doing adequate supervision resulting in poor quality of TB services. Therefore, it is demanded that the RNTCP should ensure regular supervision of their staff.
USE OF UNTIED FUND PROVIDED UNDER VILLAGE HEALTH AND SANITATION COMMITTEE (VHSC) FORMED UNDER NRHM
The un-tied fund under the National Rural Health Mission (NRHM) is provided for supporting Village Health and Sanitation Committee (VHSC) meetings. This fund can be used to improve TB programme performance. Therefore the participants demanded that a guideline should be issued under NRHM to use the un-tied fund of VHSC to support travel of TB patients for sputum examination and treatment.
PROVISION NUTRITION SUPPORT FOR TB PATIENTS
It is essential to provide nutritional support from the existing /other government schemes. Linkages of TB programmes with such existing nutritional schemes should be established and strengthened, such as Antodaya (where people below poverty line can access free food grains from public distribution system – PDS), mid-day meal (children in government schools have access to mid-day meals), among others.
STRENGTHENING PARTNERSHIP WITH CIVIL SOCIETY UNDER RNTCP
The meeting participants asserted that enough funds are available for civil society participation in TB programmes under RNTCP schemes which are currently not being utilized. There was a demand to use these resources to meaningfully engage civil society (especially those who have experienced TB in their lives) in TB programmes at all levels.
IMPLEMENTING BAN ON TB SEROLOGICAL TESTS
Ban on TB serological tests should be strictly implemented. Manufacture, sale, use and import of irrational and inaccurate TB serological tests (also referred to as blood or antibody test for TB) were banned ‘with immediate effect’ as per a gazette notification which was issued by the Ministry of Health and Family Welfare, Government of India, on 7th June 2012. This notification is part of the Drugs and Cosmetics Act, 1940. The serological test for TB is widely used in the private sector, even though they are known to be inaccurate, inconsistent and with no clinical value for TB diagnosis. Diagnostic centres in UP are using these tests even in July 2012. UP government must ensure patients don’t have to waste their money, and take strict action against doctors, healthcare providers, other staff, laboratories or manufacturers for violating this order. UP government must instruct inspectors appointed under Drugs and Cosmetics Act, 1940, to implement the ban in an effective manner.
Let’s hope people’s voices are heard by the UP government and effective change comes in ‘with immediate effect’ too (just in the spirit with which the government order mentions the phrase!).
Bobby Ramakant – CNS