New Delhi: A change in the procurement process for a key consumable used for tuberculosis (TB) testing has left states with machines they can’t immediately use. This, at a time when the Revised National TB Control Programme (RNTCP) was mounting a recovery after reporting of the disease suffered due to the lockdown and diversion of resources to tackle the Covid-19 pandemic.
In March this year, a decision was taken to change the process for central procurement of cartridges employed in CBNAAT machines that are used to test TB patients for drug resistance.
Earlier, the cartridges, which cost around Rs 1,200 each, were centrally procured and given to states. However, the central government decided to decentralise the process this year, which means states will now have to get their own supply. With programme implementation plans (PIPs) for the National Health Mission already drawn up and finalised, states are now starting the procurement process from scratch.
“Accordingly, to further empower states in ensuring the uninterrupted availability of laboratory diagnostics, it has been decided for the decentralisation of procurement of all lab consumables used under National TB Elimination Programme (NTEP) at states. The states may request for the budget required for the procurement of lab consumables in their respective PIPs. The kind grants issued under the NTEP will also be suitably converted to cash grants,” read the 26 March letter to states, a copy of which is with ThePrint.
ThePrint reached the health ministry and the officers concerned over email and WhatsApp for a comment, but did not receive a response till the time of publishing this report.
For many states, the issue isn’t funds but the procedural lag that has forced them to either not use the CBNAAT machines at all or use them only for cases where it is absolutely essential.
The CBNAAT machine, which is a foreign-manufactured device, uses one cartridge to detect drug-resistant TB and also to test whether the pathogen in question is resistant to rifampicin, one of the most commonly used drugs against TB.
Also read: Covid’s unseen toll in India — 38% dip in screening for TB that’s still a major health crisis
Case study Bihar
Bihar was looking at procurement of 50,000 CBNAAT cartridges at a cost of Rs 6 crore, but the matter is now pending approval with the state cabinet.
Dr B.K. Mishra, state TB officer, told ThePrint, “We have got the money but we had asked the Bihar Medical Services Infrastructure Corporation Limited to draw up the rate contract and shared the specification with them. That has been done but the matter has to be cleared by the cabinet. All states are facing similar issues.”
He said the state has about 1,000 CBNAAT cartridges left which they are now using on priority patients only. Other patients are being screened using Trunat, he added.
Trunat is an indigenously manufactured TB testing device that performs the same function as CBNAAT, but with two different cartridges. Officials say the function and efficiency of both machines is the same. It’s the fact that one half of the inventory has been rendered unusable that is affecting the programme.
“This problem is being faced almost by all states,” Dr Mishra said.
Bihar, which has one of the largest TB burdens in India, has about 70 CBNAAT machines and a little over 200 Trunat machines. Many of them had been diverted for Covid testing at the peak of the pandemic. But now, even though they are available for the TB programme, states cannot use them to capacity.
TB kills an estimated 4,80,000 Indians every year and around 1,400 every day, according to government data.
The National Strategic Plan for TB elimination says India also has more than a million ‘missing’ cases every year that are not notified, and most remain either undiagnosed or unaccounted for, and inadequately diagnosed and treated in the private sector. India has vowed to eradicate the disease by 2025, five years ahead of the global schedule of 2030.
Dr Santosh Gupta, the state TB officer in Uttar Pradesh, said: “We have placed orders (for the cartridges). The delay is on the part of the company.”
In Rajasthan, all 60 CBNAAT machines are out of use currently, state TB officer Dr Vinod Kumar Garg said. “We are using Trunat machines. The purchase process is on, so we are hoping to get the cartridges soon.”
Also read: Clock is ticking on tuberculosis and Covid is making it worse. Old ways won’t work
Cartridge prices could go up
Officials of states point out that while the delay may be temporary, the fact that the cartridges in question are proprietary items — i.e., only one company manufactures them — means that there is not going to be any price discovery through tendering.
A state TB officer, speaking on the condition of anonymity, said, “We cannot tender because there is no competition. Earlier, when the Centre procured, it did so in bulk, so it obviously got better prices. But now the situation is that there is one vendor and multiple buyers, none of whom would ever procure as much as the Centre did. So we are definitely looking at an increase in prices. I cannot say (by) how much, but I am counting on the cartridges that cost about Rs 1,200 apiece going up to something like Rs 1,600.”
However, officials say the decentralisation also means that states can procure according to their necessity and take up any issues, including expiry etc, directly with the company.
“Last year, TB reporting was severely affected because of diversion of manpower. Almost 100 per cent of manpower was diverted and then the lockdown happened. This time we are trying to regain lost ground, so the sooner the machines start working the better it is,” the officer said.
Kerala, however, has already managed to procure the cartridges. “We gave an order to the Kerala Medical Supplies Corporation and cartridges are already here,” said state TB officer Dr Sunil Kumar M.
(Edited by Manasa Mohan)
Also read: Covid could derail India’s pledge to eliminate tuberculosis by 2025 — ICMR medical journal