Incentives-linked plan to detect TB cases

Published in The Hindu on September 11, 2012

The national strategic plan for TB control for 2012-17 developed by the Union Ministry of Health & Family Welfare has raised the bar for tackling the fast- growing TB epidemic in the country. The main goal of the strategic plan is to provide universal access to early diagnosis and effective treatment.

According to the draft report of the fifth Joint Monitoring Mission (JMM) of the Revised National Tuberculosis Control Programme , the strategic plan, if implemented in full earnest, would save about 7,50,000 lives over the next five years.

To achieve this goal, the JMM has recommended some commendable strategies.

At the outset it has recognised the compulsion to comprehensively engage with the private sector for “prompt and accurate diagnosis, and appropriate care.”

The government had very recently made TB a notifiable disease. This will help in maintaining a national record of every patient who is diagnosed with TB by doctors in the private and public sector. In order to achieve maximum co-operation from the doctors, the report has, for the first time, spelled out the need to provide incentives for reporting cases.

Apart from stopping easy availability of anti-TB drugs, there are plans of “restricting the availability of impending new anti-TB drugs to authorised outlets.” This would be done by putting in place stringent and accountable distribution controls.

Another novel recommendation is to make available subsidised anti-TB drug kits to the private sector on a quid pro basis. The availability of the subsidised kits would be “linked to notification and programme-provided treatment support.”

A tectonic shift is being planned in the way new cases are detected. The current system is a passive one, wherein case detection is initiated by the patients themselves. This greatly reduces case detection. To overcome this hurdle, there are plans of introducing a “provider-initiated screening pathway.” This will focus on clinical risk groups and socially vulnerable groups.

Another way of increasing the number of TB patients diagnosed is to provide automated electronic payments for both referrals and treatment support. Using automated electronic payment mode would avoid the problems of delay or failure in payment.

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