community engagement on TB

(Mains GS 2 : Issues Relating to Development and Management of Social Sector/Services relating to Health, Education, Human Resources.)

Context: 

• The World  Health Organization (WHO) reported that in 2021 tuberculosis (TB) cases globally had risen for the first time in decades.
• India TB Report 2022 noted a 19% increase in 2021 from the previous year in TB patients’ notification as the number of incident TB patients notified during 2021 was 19,33,381 against the 16,28,161 in 2020.

Community engagement:

• India’s recent political focus on the tuberculosis disease that kills over 1200 Indians every day is welcome but its focus on engaging communities in this effort, though a critical need, remains poor and directionless. 
• These efforts are often supported by international agencies and nonprofits who choose to provide minimal contractual pay to TB survivors to engage in high-risk work. 
• The model touted as success would be inequitable, racist and discriminatory anywhere else in the developed world but in low-income, high-burden countries, it is termed as empowerment.  

Undernutrition and TB are “syndemics”:

• The 2019 Global TB report identified malnutrition as the single-most associated risk factor for the development of TB, accounting for more cases than four other risks, i.e., smoking, the harmful use of alcohol, diabetes and HIV.
• Undernutrition and TB are “syndemics” and the intake of adequate balanced food, especially by the poor, can work as a vaccine to prevent TB. 
• This vaccine is “polyvalent, acting against many gastrointestinal and respiratory tract infections; orally active, that can be produced in the country without patent rights; dispensed over the counter, without prescription and without any side-effects; safe for children, pregnant and lactating women, and of guaranteed compliance because it brings satisfaction and happiness”.

False model: 

• The government and international agencies are effectively creating the narrative that those who are affected by TB and are poor deserve poor care, and their role is merely limited to low-wage labour and not seeking accountability or rights.  
• Such models are even more damaging when we consider the long-term impact as such models are appreciated by agencies that otherwise spout equity, it is the effective end of advocacy for improvement in quality of care. 
• Once adopted and institutionalised, these paradigms normalise substandard care in TB, diminishing the rights of the vulnerable to access high-quality care.

Diagnosis and treatment:

• While the government sector is stretched, lacking infrastructure, the private sector has a record of overuse of diagnostics and treatment.
• According to the National Family Health Survey (NFHS), the private sector provides care for over 60 % of all Indians at some point or another.
• TB-affected individuals often face isolation and discrimination within the health system, families and communities, yet the government efforts in addressing stigma remain uneven with periodic anti-stigma campaigns. 
• A large percentage of TB-affected persons have mental health problems, right from diagnosis till post-cure which impact patients' ability to continue treatment. 

Way ahead:  

• The quality of TB service in India remains poor, undignified and often unaffordable. 
• We need to increase investment in TB infrastructure for diagnosis and treatment in the public sector. 
• We must expand capacity for reliable testing for detection of both drug-sensitive and drug-resistant TB.
• We also need to create a long-term strategy to engage the private sector.

Conclusion:

• The efforts to end TB will remain incomplete until we increase NPY support as social and mental health support as an essential part of TB care. 
• A long-term stigma mitigation strategy in communities and for affected individuals and families is critical.