It was in May 2012 that the Government of India had made it mandatory for private practitioners in the country to notify the local health authorities about cases of tuberculosis. The TB notification was issued to improve adherence and completion of the treatment and also to fight the steadily rising cases of drug-resistant TB.
Three years down the line, while a majority of the private practitioners do know about the Central government notification, experts who are following the developments, however, point out that the notification has not shown the desired results. In fact, in Telangana, roughly, TB notification by private practitioners is just over 10 per cent, while the rest of the reported cases are the patients who are getting treated under the State-sponsored Revised National TB Control Programme (RNTCP). To make TB reporting easy, the GOI had also launched NIKSHAY, a web based portal that will enable practitioners to directly enter TB cases into the database.
However, there have been a series of surveys in various parts of the country that have indicated that caregivers are not aware of the existence of NIKSHAY. Experts in TB in Telangana and Andhra Pradesh also point out that there is a clear trust deficit between the government and a doctor who has a private practice. “Private practitioners hesitate to report TB cases because they are afraid that they would lose the patient once they make the case official. A TB patient is a huge source of income for doctors because they have to be under their care for at least six to eight months,” doctors said.
There is no dearth in systemic problems in implementing the notification. It’s difficult to goad a private practitioner into entering data in the web-based portal. The local TB officers have tried their hand in manually collecting the TB data from individual doctors, which has complicated the issue because of ‘lack of commitment’ shown by contract workers responsible for collecting data.
“It’s a misconception that private practitioners will lose their patients. They are just supposed to declare the numbers, that’s all and not give the details of the patients. Moreover, private doctors too should have some social responsibility to report cases on their own,” says K. Subhakar, Zonal Task Force Chairman for RNTCP.
Experts have also called for punitive measures for those who avoid and a form of appreciation for those who do. “There should definitely be a system wherein punitive action can be taken on private doctors who do not report TB cases. At the same time, there should be appreciation for this who report cases meticulously,” suggests State Headquarters Consultant, WHO, RNTCP, C. Chakrapani. TB treatment, adherence and reporting can also be improved if TB drugs are made available from one centralised location. “There is a pilot project in progress in a few districts in Gujarat and Bihar where TB drugs are available only at one location for a population of 10,000 persons. A lot of groundwork, however, has to be done to implement such a scheme,” Dr. Subhakar added.
– M. Sai Gopal
