If we were to respond to the 2012 World Tuberculosis Day challenge of stopping TB, it would involve expanding TB services within and by the private sector and within and by the community, Nevin Wilson, Regional Director (South-East Asia Office), International Union Against Tuberculosis and Lung Disease, said.
While it is necessary to recognise the strength of the Revised National Tuberculosis Control Programme (RNTCP), it is necessary to involve the private sector and community aggressively, Dr. Wilson said, delivering the REACH Oration on ‘Tuberculosis Control in India: How Can we Do More.’ To do so, and expand the scope of RNTCP would require a flexible and innovative approach, he added.
According to a 2011 study in 30 districts in 15 States, 46 per cent of those accessing medical care for TB were doing so out of the public health care system. Although India was notifying its TB cases through the Programme, a large number of cases being identified outside it were not being notified.
Another study in Delhi about treatment-seeking patterns showed that not even one patient reached a DOTS Centre first. Two thirds of the sample first went to an informal provider, and then shopped around between formal providers and chemists before TB is identified and treated. Less than a third sought care within a month of onset of symptoms, and for women, over six months lapsed before they actually went to anyone for treatment.
Recalling Robert Koch’s (who isolated the TB bacillus) advice, Dr. Wilson said the maxims still hold good: Doctors must be able to diagnose TB accurately; Diagnosed cases of TB must be notified to a central authority; and all those notified must be covered under treatment. Case finding strategy, traditionally passive — waiting for the patient to land up seeking care — must also change, he added.
Go active
It was time to shift to the active mode — looking at high-risk populations, and educating the community to raise the demand for public services. As for the private sector, it was important for them to align themselves to treatment regimes built on evidence-based guidelines. A national treatment plan is essential to prevent drug resistance, and the stress on adherence to treatment is crucial, Dr. Wilson said.
Further, he expanded on the message of World TB Day 2012, calling upon the public to see itself as an agent of change, and not merely as a patient.
Earlier, M.S. Swaminathan, Rajya Sabha MP, and chairman, REACH, presented Dr. Wilson with the oration award.
