Relevance : GS Paper II
Theme of the article
An end to TB is not possible till we end malnutrition, poverty and poor sanitation.
Context
The Annual India Tuberculosis (TB) report was released by the government in September. India is now home to about a quarter of the total global TB patients. The current government is committed to ending TB in India by 2025.
About the TB report
- As per the report, 21.5 lakh TB cases were reported in the country in 2018 — the highest number of TB cases registered in any country.
- The report says that with the introduction of Nikshay, the computer-based surveillance programme for TB patients, the reporting of TB cases has improved dramatically.
TB: a social disease
- Over the last century or so, it has been established beyond doubt that TB is more of a social disease owing its roots to poverty, malnutrition and poor sanitary conditions.
- It is thus important to evaluate India’s TB report in the context of two developments — India’s continuing downfall in the Global Hunger Index (GHI) and the declaration of our villages as ODF.
Barriers to TB notification
- Despite a national notification system — of Nikshay — other factors like patient confidentiality issues, poor knowledge of notification system, etc, prevented notification of TB patients in a hospital setting. These factors are social and without intervening at that level, it is hard to believe that the notification of TB cases can reach a significant number vis-à-vis ending TB by 2025.
- The GHI report, in which India ranks 102, is another stark reminder of what else is wrong in claiming that TB can be ended by 2025. A hungry India cannot be free of TB. Dietary deprivation is a direct indicator of inequality. Unequal societies cannot be made free of disease and infirmity. The proportion of malnutrition in TB patients was nearly 60 per cent.
- TB and sanitation have a direct causal relationship. There was no statistically significant reduction in the occurrence of vector-borne epidemics in the country, two years after the launch of Swachh Bharat Abhiyan (SAB).
The private sector
- Of the total notifications, 5.4 lakh cases were from the private sector, an increase of 40 per cent from last year.
- Over the last decade or so, there has been a near-complete takeover of India’s health sector by the private players.
- Data shows that more than 80 per cent of healthcare is now being delivered by private health enterprises — something is evidently not right with the public health system.
- With a virtually unregulated private health system, an increase in notification of TB patients could be heartening for the government. But for the public health system, it is bad news.
Conclusion
An end to TB is not possible till we end malnutrition, poverty and poor sanitation. We need a paradigm shift in the response to TB. This should include a more sensitive approach on gender and towards the underprivileged.
