Civil society appeals to strengthen TB control in Andhra Pradesh

Civil society organizations came together in Hyderabad today to enlist gaps in tuberculosis (TB) control programme in Indian state of Andhra Pradesh and appeal to authorities to strengthen the TB response. Partnership for TB Care and Control in India, along with LEPRA Society, Catholic Health Association of India (CHAI), Catholic Bishops Conference of India – Coalition for AIDS and Related Diseases (CBCI-CARD), Damien Foundation India Trust, David and Lois Rees Hospital, Shivananada Rehabilitation Home, TB Alert India, Vasavya Mahila Mandali, World Vision India, Christian Association for Medical mission and People's development (CAMP) and Rayalaseema Gramena Vikas Society, submitted a memorandum to Commissioner, Principal Secretary (Health) of AP Government, among others.

Civil society networks in Andhra Pradesh enlisted key challenges in TB control programme (formally called the Revised National Tuberculosis Control Programme - RNTCP) in the state.

Not only shortage of drugs and consumables is counter-productive to public health but also slows down the progress of RNTCP in its fight against TB. The members reported non-availability or shortage of Streptomycin injection for TB patients, paediatric and multidrug-resistant TB (MDR-TB) drugs; non-availability or shortage of sputum cups or laboratory consumables and need to ensure microscopes are functional and in order at all designated microscopy centres (DMCs) in the state as key challenges.

Given the high burden of TB it is imperative to not only ensure that all vacant positions in TB programme are filled but also that those appointed attend to their duties with honesty and are available during working hours. Civil society members appealed for a full-time RNTCP staff on a priority basis to ensure patient-friendly services in TB care. Some of the key positions such as those of district TB control officers (DTCO), medical officers, laboratory technicians, senior tuberculosis supervisors (STS), senior tuberculosis laboratory supervisors (STLS), TB health visitor, among others were reported to be vacant. There were complaints that some of those appointed are not available during duty hours or are insensitive towards the patients. DOTS providers were not getting their due incentives on time which is one factor to demotivate them.

Two major progressive advancements in TB policy in India last year were making TB a notifiable disease and ban on TB serological tests. The notification of TB implies that each and every TB cases treated either at public or private facility should be notified to the government. The serological test for TB is still being used in the private sector, even though they are known to be inaccurate, inconsistent and with no clinical value for TB diagnosis. There was a clear demand from the civil society for the government to ensure that all TB cases from private and public sector are notified and ban on TB serological tests is strictly implemented.

According to the World Health Organization (WHO), TB is a contagious disease related to poverty, under-nutrition and poor immune function. People with active TB are often malnourished and suffer from micronutrient deficiencies as well as weight loss and decreased appetite. Malnutrition increases the risk of progression from TB infection to active TB disease. So it is not only a public health imperative but also pragmatic to synergise between different government schemes such as those on nutrition or food security and RNTCP. Linkages of TB programmes with such existing nutritional schemes should be established and strengthened, such as Antodaya Yojana (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.

RNTCP has increasingly recognized the positive outcomes of partnering with civil society and encouraged its participation. State TB control programme in Andhra Pradesh may do more on engaging civil society as equal partners with dignity, and encourage their active participation at all levels. But these opportunities where state TB control programme and civil society can work together have been under-utilized in the state which is evident from the following:
- Financial grants for NGOs signed under various RNTCP schemes have not been released for last two years
- At district level, RNTCP schemes for NGOs were not sanctioned even after submission of application by interested and eligible NGOs
Civil society members felt that the state TB control programme must ensure participation of all stakeholders including civil society representatives in the quarterly review meetings at district level.

Under the National Rural Health Mission (NRHM), untied funds have been provided as part of the Village Health, Sanitation and Nutrition Committee (VHSNC). These untied funds are to support VHSNC meetings.  Civil society members opined that guidelines should be issued by NRHM to use these untied funds of VHSNC to cover travel costs of TB patients for sputum examination and treatment. This will go a long way in enhancing RNTCP's commitment towards intensified case finding, improved treatment adherence and success rates.

The civil society members handed a memorandum enlisting the above challenges and reinforced their commitment to work as equal partners with the state TB control programme to help achieve RNTCP targets and reduce human suffering due to TB. Let's hope the state government authorities pay cognizance to these appeals and improve the TB response in the state.

Bobby Ramakant, Citizen News Service - CNS
February 2013 

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