The unregulated private healthcare sector has emerged as the key focus in India’s fight against tuberculosis (TB). Last week, the Lancet Commission on TB said nearly eight million TB deaths can be averted in India between 2019 and 2045 only if private sector engagement is optimised.
“We have undertaken many programmes that exclusively focus on the private sector’s engagement in TB care. There are standard guidelines for treating TB which are applicable for doctors in public hospitals as well as private doctors. Our focus is to engage the private sector and get the doctor to follow these guidelines,” Dr. Kuldeep Singh Sachdeva, Deputy Director General, Central Tuberculosis Division told The Hindu .
Nearly 70% patients in India first visit private healthcare providers. The problem begins with the wrong diagnosis and inaccurate treatment by unqualified, under-qualified and profit-seeking healthcare providers who fail to refer the patients for the right treatment. Thus, a large number of patients develop drug resistance by the time they reach the qualified treatment providers.
“A standard of care has to be in place and it has to be implemented thoroughly,” said Dr. Nerges Mistry, Director of the Foundation of Medical Research. The private sector is heterogeneous, and consists of good doctors, bad doctors, and even illogical ones, said Dr. Mistry.
The Commission has said engaging private providers can reduce unnecessary morbidity and mortality caused by inappropriate treatment, drug resistance caused by undetected Multidrug-Resistant (MDR) TB and incomplete treatment, and catastrophic expenditures and impoverishment.
Mumbai’s TB officer Dr. Daksha Shah said things are improving gradually. “We have been focussed on engaging private doctors over the past three years. This has resulted in some positive developments. For example, in 2018, nearly 20,000 TB cases were notified by the private sector. Out of the 5,000-odd MDR cases, almost 2,000 were notified by the private sector,” said Dr. Shah.
The notification of TB cases by private doctors has improved across the country as well. According to Nikshay, a web-based platform started by the government to update and track TB cases, 3,91,615 cases were notified from the private sector in 2017 and 5,41,877 in 2018. This year, the private sector has notified 95,666 cases till Monday. This, of course, does not mean private doctors are prescribing the right treatment, said a doctor. Chest physician Dr. Zarir Udwadia from Hinduja Hospital blames the poor prescribing practice of private doctors for India’s MDR TB crisis.
In his recent article, Dr. Udwadia said, “50% of practising doctors are of alternative faiths like homoeopathy, ayurveda, and unani, but would not hesitate to take on the initial management of these challenging cases, serving only to amplify resistance with poor prescriptions.”
He said a study in Dharavi showed that only 3% of the doctors practising there were able to provide a correct prescription for a patient with MDR-TB.