“47% of TB cases are being missed by the state TB programme” said Dr. DN Dewangan, State TB Officer in Chhattisgarh (every year, expected number of TB cases in Chhattisgarh is 51,840 and number of those TB patients registered under the revised national TB control programme (RNTCP) is 27,300). Dr. Dewangan was speaking at the consultative workshop for the TB and poverty sub-working group of the Stop TB Partnership, secretariat of which has now moved to the South-East Asia office of the International Union Against Tuberculosis and Lung Disease (The Union).
Chhattisgarh is a low intensity internal conflict ridden Indian state where 80% of population is living in rural parts and 32% are tribals. Nine out of eighteen districts are inhabited by tribal population. Poverty further exacerbates the situation denying access to existing healthcare services including those for TB. Hope these issues are well addressed by the forthcoming 41st Union World Conference on Lung Health in Berlin, Germany.
Either these 47 per cent TB patients who are currently not being served by TB programmes in Chhattisgarh, are unable to reach the health system due to a range of reasons, or are being diagnosed and treated by unqualified or qualified private healthcare practitioners, said Dr Dewangan.
Involving qualified or unqualified private healthcare practitioners, non-governmental organizations (NGOs) and other sectors might help reach the unreached TB patients.
The state TB programme is making efforts to involve unqualified private practitioners in both rural areas and urban slums so that they may refer TB suspects and consider acting as DOTS providers, said Dr Dewangan.
Qualified private practitioners are also being engaged in state TB programme through the Indian Medical Association (IMA).
NGOs like CBCI are doing commendable work in complementing the state TB programme, said Dr Dewangan.
Public sector hospitals like those of SAIL, NTPC, Indian Railways, among others are also being engaged by the state TB programme to reach the unreached pool of TB patients and provide them with quality diagnosis and treatment.
The Chhattisgarh state TB programme is also making efforts to reach out to the unreached TB patients in refugee communities. The state TB programme has established designated microscopy centres (DMC) at two refugee camps: Mainpat Tibetian camp and Mana Bangladeshi camp.
Another DMC is functioning inside two central prisons in Chhattisgarh in Bilaspur and Raipur cities.
To reach the unreached TB patients among 32% tribal population in Chhattisgarh state, the programme is implementing a Tribal Action Plan under which they are running one DMC for every 50,000 population and providing cost to meet travel expenses to tribal people.
The Chhattisgarh state TB programme has also scaled up the advocacy, communication, and social mobilization (ACSM) activities in local vernacular language, and use mass gatherings like ‘haat bazaar’, ‘mela’ or fair among others to reach the unreached TB patients.
The Chhattisgarh state has DMCs as per population norms in both tribal and non-tribal districts but still 47 per cent of TB patients are being missed. Few new DMCs are proposed to be established in 2010-2011 plan to improve access to diagnostic services said Dr. Dewangan.
There is no user charge for sputum microscopy, said Dr. Dewangan. Also there is no user charge for X-rays during the diagnosis of TB.
Moreover in Chhattisgarh, the state TB programme has linked with the existing nutritional schemes to provide nutritional support to TB patients if required, said Dr. Dewangan.
The public health challenge is compounded by internal conflicts in Chhattisgarh and despite of the above efforts of the state to reach out to the unreached TB patients, 47 per cent of the estimated TB patients are either being missed or being managed by the private sector (DOTS is mostly in public sector healthcare settings). Clearly a lot more needs to be done, and rolling out the Patients’ Charter for TB care, which is a rights and responsibilities based framework, to engage former TB patients in reaching out to their communities and improving TB programme performance by community centric approaches, should be seriously considered.