World Tuberculosis Day 2017 - Unite to End TB: Leave No One Behind

World Tuberculosis Day 2017 - Unite to End TB: Leave No One BehindNew Delhi [India], Mar. 24 : Tuberculosis is one of the top 10 causes of death across the globe, ranking above HIV and malaria. According to the World Health Organization (WHO), in 2015, there were 10.4 million new cases of TB worldwide.

Six countries account for 60% of the total TB deaths, with India leading the count, followed by Indonesia, China, Nigeria, Pakistan and South Africa. As per WHO, each year about 2.2 million people develop TB in India and an estimated 220,000 die from the disease.

Despite many initiatives, over 4,000 people lose their lives each day to this leading infectious disease. Many of the communities that are most burdened by tuberculosis are those that are poor, vulnerable and marginalized. WHO is calling upon countries and partners to "Unite to End Tuberculosis" this year.

The call comes as we enter the era of the Sustainable Development Goals (SDGs). Ending tuberculosis (TB) by 2030 is a target of the SDGs and the goal of the WHO End TB Strategy.

On the occasion of World TB Day on March 24, 2017, CARE India recommends:

• Greater investment in health: India needs to give priority to and begin investing in health. For decades, governmental expenditure on health has been one of the lowest in the world at 1.4% of the GDP (but even lower in the previous years).

While the 2017 Union Budget has allocated additional funding for health, the allocation will substantially fall short of the 2.5% of the GDP that has been considered a realistic goal in the draft National Health Policy 2015. The budget for India's Revised National TB Control Program (RNTCP) also needs to see an increase.

• Universal Access: One-third of people estimated to have TB are either not reached for diagnosis and treatment by the current health systems or are not being reported. Even in patients who are identified, TB or MDR-TB is often diagnosed and treated late. In order to reach the unreached and to find TB patients early in the course of their illness, a wider range of stakeholders already involved in community-based activities needs to be engaged.

These include the nongovernmental organizations (NGOs) and other civil society organizations (CSOs) that are active in community-based development, particularly in primary health care, human immunodeficiency virus (HIV) infection and maternal and child health, but have not yet included TB in their priorities and activities. Existing community structures need to be empowered to identify suspects, facilitate referrals, provide patient support and effectively supervise DOTS provision to increase adherence and treatment completion.

The activities should also include community mobilization to promote effective communication and participation among community members to generate demand for TB prevention, diagnosis, treatment and care services. These initiatives will increase community support for TB care, reduce stigma and augment demand for quality services there by playing a significant role in achieving universal access.

• Private Sector need to come forward and join hands with for Ending TB: Utilization of private services in addition to existing public health services is essential for Universal Access for TB Care. It is important for private practitioners to follow Standards for TB Care in India, and use the correct drugs and combinations.

Pharmacists should avoid dispensing antibiotics without prescriptions, and instead refer patients with chronic cough for TB testing. Every TB patient, along with close family members, should receive detailed counselling on the critical importance of completing treatment.

TB patients need quality care, regardless of whether they chose to seek care in the public or the private sector. Therefore, it is also important for the private sector to work hand in hand with the RNTCP, and improve the overall quality of TB care in the country.

• Tackling the social determinants of health is essential: India must start to seriously tackle key determinants of TB, especially poverty, undernutrition and tobacco smoking, which have been clearly linked with TB and mortality due to TB. This will require inter-sectoral collaboration between multiple ministries, agencies and civil society.

There is also significant opportunity for inclusion of TB in social protection programmes, which can focus on prevention as well as protect patients from impoverishment. There is need to think about more innovative community based solutions which are sustainable and have more community ownership.

• TB and HIV: TB is a leading killer among HIV-infected people with weakened immune systems; a quarter of a million TB deaths are HIV-associated. In India, TB is responsible for the death of every third AIDS patient. Collaborative tuberculosis/HIV activities, and management of co-morbidities is necessary. HIV-induced TB can be effectively addressed through workplace interventions among formal/informal sectors. Public education is of special significance here.

• TB control is a comprehensive multi-sectoral effort: Initiatives needs to involve better management of primary health-care infrastructure in rural areas; regulated private health care leading to widespread irrational use of first-line and second-line anti-TB drugs; effective control of HIV infection and addressing root causes of widespread malnourishment and poverty. It is imperative to engage with private sector and community based care providers to improve early notification, treatment adherence and outcome for TB patients. (ANI)