National partnership for TB care and control shapes up in India

Photo by busymommyA national multi-stakeholder partnership for tuberculosis (TB) care and control is shaping up in India.

On 4 November 2008, representatives from a range of TB-focused organizations participated in a meeting at the LRS Institute of Tuberculosis and Respiratory Diseases in New Delhi. The meeting was facilitated by the International Union Against Tuberculosis and Lung Disease (IUATLD) India Resource Center.

India is ranked first on a WHO list of 22 high-TB burdened countries and the country is home to about one fifth of the world’s TB cases. According to WHO’s 2008 anti-TB drug resistance report, India and China are responsible for more than 50% of the world’s drug-resistant TB cases and India is home to a number of cases of multi-drug resistant TB (MDR-TB).

But India has made considerable strides towards better TB care and control, testing more than 40 million people for TB and rolling out anti-TB treatment to more than nine million people with the disease since 1997.

Every month more than 100,000 people with TB are put on Directly Observed Treatment, Short-course (DOTS) and India has reported a cure rate of 85% among people with TB. However the poor performance of DOTS programs has resulted in increases in the amount of drug-resistant cases.

According to Dr LS Chauhan, Deputy Director General for TB with the Directorate General of Health Services, “Partnerships in TB care and control are not new to India.”

“Since 1995, India has forged partnerships with different sectors to improve TB program performances,” Dr Chauhan said. “Despite the involvement of more than 2500 NGOs, private practitioners, 260 medical colleges and 110 corporate sector hospitals . . . the contribution of the TB programs is not at the desired level.”

“There is a need now for close coordination and clear communication while working together to face the challenge of including those who are currently outside the reach of the public health system.”

Recent reports have identified a number of issues impeding responses to TB in India, including limited community awareness, sub-optimal community participation, issues of TB and HIV co-infection and the emergence of drug-resistant strains of the disease.

“Eight million new TB cases are diagnosed every year and two TB deaths take place every three minutes in India,” Dr D Behera, Director of the LRS Institute of Tuberculosis and Respiratory Diseases in New Dehli, said.

“Just providing anti-TB treatment is not sufficient. Treatment is interrupted due to poverty, unemployment.”

Robin Mardeusz of the United States Agency for International Development (USAID), said partnerships provide multi-active and innovative solutions to these problems.

“At USAID, partnerships are the way to do business. Partnerships enhance efficiency and effectiveness, rational division of labour, maximize synergy,” Mardeusz said.

A civil-society TB partnership that has been operating in India since March 2007 to complement India’s Revised National TB Control Program is the NGO TB Consortium which includes eight major civil society organizations contributing to TB care and control—the Adventist Development Relief Agency, the Damien Foundation India Trust, the German Leprosy and TB Relief Association, the LEPRA Society, PATH India, Project Concern International India, TB Alert India and World Vision India.

How this partnership will complement other efforts remains to be seen and the goals of strengthening information exchange platforms, genuine dialogue and TB advocacy remain daunting challenges.

Maybe it is time to step out of our organizational entities and join hands for stronger efforts to help communities affected by TB and push India achieve the prevention, treatment and care targets it has set.

Bobby Ramakant-CNS