The government, as part of the World Health Organization’s End TB Strategy, is tightening the regulatory mechanisms to curb improper prescribing practices of anti-tuberculosis drugs and engage the private sector physicians better so that every case of TB in the State is accounted for.
Even though TB is officially a notifiable disease in the country since 2012, a good number of cases which are diagnosed and treated by private sector physicians never get accounted for, as these cases are not entered into NIKSHAY, the Health Ministry’s official Web-based TB case notification network.
TB drug resistance is fuelled by exposure to inadequate treatment, unregulated availability of TB drugs, and irrational prescriptions.
In Kerala, where TB treatment still carries a stigma and where a patient’s confidentiality is a major issue directly affecting treatment, the private sector cannot be excluded from the provision of TB care.
“We have decided to launch certain key interventions in a campaign mode as part of the End TB Strategy to ensure that there are no irrational prescriptions, that every TB patient is followed up till the completion of the treatment course and that the emergence of multi-drug resistant TB is contained,” says Rajeev Sadanandan, Additional Chief Secretary, Health.
The State TB Cell estimates that there are approximately 40,000 cases of TB annually in Kerala, of which about 23,000 are being treated in the government sector. This means that over 15,000 cases are being treated in the private sector. However, in 2015, the number of cases notified by the State’s private sector in NIKSHAY was just 6,744.
The Health Department’s concern regarding these “missing” cases is that these patients might not be followed up regularly as they are outside the national programme.
TB drugs are highly toxic with various side-effects and if the patient does not complete the treatment course, drug resistance might result.
These “missing” cases can be found only if the sale of anti-TB drugs in the private sector is monitored.
In 2013, the Centre identified 46 drugs, including first line anti-TB medicines, to be included under a new schedule (H1), which specifies that the drugs must be sold on a prescription by qualified medical practitioners and that the pharmacist must maintain a record of the drugs sold, details of the prescribing provider, and the name of the patient.
“This was not being practised by pharmacists seriously till now. We are now asking all pharmacists to strictly enter the TB drug prescriptions in the Schedule H1 register along with the name of the doctor. The district TB officer will check this register and follow-up with the doctors and tell them that every case has to be notified,” Mr. Sadanandan said.
These patients can continue their treatment in the private sector as long as the proper drug regime is followed and the doctor ensures that the course has been completed.
The department has also decided to go in for active TB case finding amongst the tribal and coastal population. Poor nutrition is a major issue which can have serious adverse effects on the treatment of TB. Hence, the department will also focus on providing supplementary nutrition in vulnerable areas.
“Kerala is much ahead of the rest of the country when it comes to meeting the End TB Strategy goals and the TB containment targets in the UN Sustainable Development Goals. The WHO SEARO (South-East Asia Regional Office) has now expressed its interest to work with us and to give us technical support to achieve these targets,” Mr. Sadanandan added.
