Editorial: No room for haste

Published in The Hindu on October 2, 2012

The past year has witnessed unprecedented official efforts to rein in the growing tuberculosis epidemic. In 2011 alone, 1.2 million new TB cases were reported while 60,000 patients already inflicted died. In reality, the real incidence, most likely was much higher — the number of new cases diagnosed and treated by private practitioners has not been factored in. It is to change this that TB was made a notifiable disease in May this year. The government had to bite the bullet as effective interventions can be taken only if a system is in place to capture the true incidence and prevalence of the disease, including the drug-resistant cases. Herein lies the biggest challenge — ensuring every new case diagnosed by the private health sector is accounted for. This can be achieved only if the government engages with the private sector by first taking it into confidence. The draft versions of the Joint Monitoring Mission (JMM) and the National Strategic Plan for TB Control, 2012-2017 have made strong recommendations to engage the private health sector to stem the spread of TB. The government, which very recently sent out guidelines on notification, requires every private health institution, including laboratories, to provide the personal details of a patient — name, address, mobile number and unique identification number (Aadhar or driving licence). The objective is to provide a support system to patients seeking private healthcare in terms of treatment initiation, adherence, follow-up and default retrieval — tasks that are beyond the private sector’s capacity.

The goal is laudable but it is quite unlikely that the TB Control programme can achieve all of its highly ambitious objectives in the short term. The most significant obstacle will be the reluctance of patients and some doctors to part with personal data. This despite the fact that such sharing is mandatory in the U.S. and many other developed countries, and that the Medical Council of India’s code of ethics warrants such sharing. Hence, consensus and confidence-building measures have to be undertaken on a massive scale to bring private healthcare providers on board and make them open to the idea of sharing details. According to the draft JMM report, about one million TB cases per year are not reported. While the National Rural Health Mission has found some innovative ways of increasing manpower, urban areas lack the infrastructure to handle additional cases. This needs fixing. Most importantly, the TB control programme, which uses the interrupted regimen, has to show flexibility and allow the private sector to continue following the WHO recommended daily fixed-dose regimen.