New Delhi: Over 3 lakh more cases of tuberculosis were reported in 2018 as compared to 2017, the highest year-on-year increase in India ever, according to Ministry of Health & Family Welfare data.
But while the numbers may suggest an increase in incidence, experts attribute it to India’s strengthened drive to detect and control tuberculosis that aims to eliminate the disease from the country in the next six years.
Tuberculosis is a contagious disease caused by bacteria, identified by the World Health Organisation (WHO) as one of the top 10 causes of death worldwide. According to government data from a 2017 report, an estimated 4.8 lakh Indians die of TB every year.
India features among the 30 countries with the highest TB burden, and is the single-largest source of new cases. According to the WHO, in 2017, India alone accounted for over a quarter (27.4 per cent) of the new infections registered.
The Narendra Modi government has set an aim to rid India of tuberculosis by 2025, five years before the target set under the UN Sustainable Development Goals, and the increased focus has seen the funding for control and treatment increase by over 300 per cent in the last three years: From Rs 640 crore in 2016-17 to Rs 2,840 crore in 2018-19.
Under the government’s Revised National Tuberculosis Control Programme, launched in 1997, diagnosis and treatment are free.
‘A welcome sign’
According to data from the government’s ‘Nikshay’ TB-tracking portal, in 2018, approximately 21.56 lakh new cases of the disease were notified in India, as against the 18.5 lakh patients notified in 2017, an increase of 16 per cent.
Speaking to ThePrint, Anant Bhan, adjunct professor and researcher in bioethics at Mangaluru’s Yenepoya, a deemed university, said the significant rise in TB notifications was “a welcome sign”.
“It’s probably not so much a result of increased number of cases as it is of better reporting,” he added. “This is largely due to the drive by various stakeholders involved in the TB programme, including the Centre’s TB Division and its partners, over the last few years to address the need for better and more reliable models to encourage notifications.”
An important factor noted in the data is the rise in the number of TB patients notified by private hospitals, which have often drawn government censure for their allegedly lackadaisical attitude towards reporting patient numbers.
According to the government’s action plan under the Revised National Tuberculosis Control Programme, half of India’s TB patients are cared for by the private sector.
However, just about one-fourth of the patients notified in India by 2018 were sourced to private sectors. Even so, data from the Nikshay portal suggests the numbers are increasing.
While private hospitals notified 3.98 lakh cases in 2017, they reported 5.4 lakh in 2018.
“The better case-reporting in the private sector has been due to initiatives to encourage private sector participation in TB response, as well as the mandatory TB reporting requirements that kicked in from March 2018 with penal provisions for failure to report,” said Bhan.
The professor was referring to the constant efforts made by the government to ensure all TB cases are notified.
In early 2018, the Ministry of Health and Family Welfare criminalised non-reporting of tuberculosis, with doctors, hospital authorities, and chemists liable to face a jail term of up to two years.
The government had also launched the Joint Effort for Elimination of TB (JEET) Project in May last year, under which doctors in the private sector were given an incentive of Rs 1,000 for every case notified to the government.
Besides this, the Indian Medical Association (IMA), the lobby of Indian doctors, has also urged all private doctors to notify every TB patient.
Not there, yet
While higher than previous years, the 5.4 lakh cases notified by the private sector in 2018 are way short of the target envisaged by the government for the year: 15 lakh.
A study in the medical journal The Lancet journal noted in 2016 that more than a million TB cases may be missing from India’s official statistics.
In the strategic plan for the National Tuberculosis Control Programme, the government weighed in on the potential impact of this gap, saying “the existing surveillance system lacks the capacity to count the large pool of privately diagnosed and treated TB cases, and what is not measured is unlikely to be improved”.
Nandita Venkatesan, a TB survivor and health activist who represented India at the UN General Assembly for the first high-level meeting dedicated to fighting tuberculosis [when], said the better year-on-year numbers were “a positive sign” nevertheless.
“The government needs to engage more with private-sector providers as they treat a larger number of TB patients compared to the public sector and are often the first point of contact for patients seeking care,” she added.