TB epidemic looms large with Rs 2,000 crore fund cut, erred policy

A warning letter submitted to the Union government, signed by TB officers of all states and Union territories, has termed the tuberculosis situation in India as "alarming", and have sought the Centre's immediate attention to prevent a situation that can go out of control.

The main reasons for this alarm are: downsizing the five year budget of Rs 6,500 crore to Rs 4,500 crore for the Revised National Tuberculosis Control Programme (RNTCP), failure to trace about 1 million TB-affected people, and rise in multi-drug resistance and unpaid and demoralised staff.

These facts are mentioned in the letter submitted to Dr Jagdish Prasad, the director-general of health services of the union government, on January 7 on the sidelines of the national review meeting of TB at Bhubaneswar.

"This may be considered an emergency, which, if not addressed, could invite a disaster for India...You must also be facing great embarrassment to hear that India is home to every fourth TB patient in the world. Every Indian feels ashamed when the certification of 'not suffering from TB' is asked for long visa applications to the US, the UK, Canada and Australia etc," the letter states.

India has over 2.2 million cases of TB, out of a global incidence of 8.7 million. However, the actual estimated number of patients is 3.1 million, which is of great concern. Lack of funds is adding to the woes in the fight against TB.

Though TB is a curable disease, drug-resistant forms are on the rise. The prime reason for the rise in drug-resistant TB is the inherent weakness of the
state-run TB control programmes and lack of awareness among patients, who do not complete six-month medication.

The letter also suggests that the private sector should be included to reach out to the 1 million "missing" TB patients, for better diagnostic methods and machines. The national policy also mandates nutritional support to TB patients and their families, who are at risk but those are seldom carried out.

A doctor said, "There is always a shortage of TB drugs, lack of labs, slow diagnostic tools, inadequate management of treatment and lack of trained personnel. Moreover, since we have failed to give the existing staff their salary dues, they are demoralised."

Dr Sanjeev Kamble, joint director and TB officer, directorate of health services of Maharashtra, who attended the Bhubaneshwar meeting, said, "Maharashtra has got just Rs12 crore in 2014-15. To manage the situation, we borrowed Rs 36 crore from the National Health Mission. However, most states were not so lucky as they were denied loans also."

According to officials, the central TB division (CTD) was supposed to get Rs 1,358 crore for the national TB programme, but got only Rs 710 crore and that's why the state's share has been scaled down drastically.

A senior TB expert from Uttar Pradesh said, "UP has asked for Rs 270 crore, but the demand was slashed down to Rs 182 crore by the central TB division. But the state was given only Rs 56 crore -- only 30% of the approved amount, which is lower than Rs 71 crore salary requirement. How are we supposed to run diagnostic and treatment services to patients?"

Deadly stats In India

37,500 Multi=Drug Resistant TB patient, estimated figures 65,000

2 patients die of tuberculosis every three minutes.

India is home to 3 lakh TB cases associated with diabetes

Box: In Maharashtra (Highest in India)

1.3 lakh cases

4,397 MDR TB cases
115 cases of XDR-TB reported in 2013