SYLLABUS SECTION: GS III (HEALTH ISSUES)

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Tuberculosis is the worst among endemic diseases, killing 1.5 million people every year (WHO).

In India, the TB capital of the world, the disease kills some 1,400 persons every day.

In the 1950s and ’60s, India was the global leader in research in epidemiology, transmission and domiciliary treatment of TB.

The National TB Control Programme of 1962 was a district based programme and was based on the model of public private participation.
But this programme failed to control TB.

The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly Observed Treatment, Short Course (DOTS) strategy, began as a pilot project in 1993.
It was launch as a national programme in 1997 but rapid RNTCP expansion began in late 1998.
The nation-wide coverage was achieve in 2006.
This programme was introduce under the supervision of WHO. But this programme had various flaws.

WHO experts, without factoring in the differences between the TB epidemiology of poor and rich countries, used a theoretical construct of TB control to design RNTCP.
The theoretical principle is ‘source reduction’. If one patient is the proximate source of infection and disease to another in the community, early diagnosis and treatment would work as source reduction.
But the case of India is other, it is a high burden country. Large proportions of adults carry TB infection in the lung in a dormant condition for life (latent TB). This will accelerate reactivation TB.
This programme is heavily funded by the government, but there is no prescribed method of monitoring the trajectory of TB control.
The assumption that treating pulmonary TB patients alone would control TB was epidemiologically fallacious in India.
RNTCP has failed to elicit people’s partnership in TB control. In India’s AIDS Control Programme, public education was given high priority. Red ribbon clubs in schools and colleges are its legacy.
Without people’s informed participation, stigma and delay in seeking help will continue

Diseases that have social determinants tend to decline over time with better housing, nutrition, education and income.
Rather than elimination we must aim for a high level of control ( lowering from 200 per lakh per year to 50 per lakh per year) and document it with measurement.

SOURCE: THE HINDU