Missing TB cases in the private sector

GS Paper II

News Excerpt:

There has been an increasing number of instances when private healthcare providers are not providing the information about the correct number of tuberculosis (TB) patients.

National TB Prevalence Survey India (2019-2021):

  • It was found that TB prevalence across all age groups was 312 per 100,000 population for the year 2021.
  • In contrast, the case notification rate in 2021 (public and private sectors together) was only 153 per 100,000.
  • As per the India TB Report 2022 - the case notification rate was 172.1 per 100,000 in 2022.

Background on TB Notification in India (2012):

  • India made notification of TB patients mandatory in 2012 to address the problem of delayed diagnosis, suboptimal quality of care, incorrect diagnostic and treatment protocols being used, and a high dropout rate in the private sector.

Increase in Private Sector TB Notifications (2012-2022):

  • In 2013, only 2% of all notified patients were from the private sector.
  • The National TB Elimination Programme (NTEP) adopted several initiatives which substantially increased the proportion of notified cases — 21% in 2017, 25% in 2018, 28% in 2019, 31% in 2020, 32% in 2021, and 30% in 2022.

Targets vs. Achievements:

  • Despite the significant increase in the private sector TB notifications over the years, they fall far short of the National Strategic Plan (NSP) 2020-2025 targets.
  • The TB notification target set by NSP for the private sector in 2020 was 35%, 45% in 2021, and 56% in 2022.
    • If the gap between what was achieved vis-a-vis what was targeted in 2020 was small, the shortfall increased by 13% in 2021 and a staggering 26% in 2022.
  • According to the target set by NSP, in 2022, the private sector should have sent 1.93 million TB notifications.
    • Yet, there were only 0.73 million notifications.
  • A staggering 1.2 million TB cases in the private sector were missed in 2022.
  • Even the NTEP’s target for expected notification in 2022 by the private sector was 0.95 million.
    • What was achieved was only 0.73 million (77%).

Public Sector vis-a-vis Private Sector notifications:

  • In contrast, the notification achieved by the public sector was 92.4% (1.68 million) of the expected notifications.
  • Based on the 2016 TB incidence of 2.8 million cases in India, of which only 0.3 million from the private sector and 1.6 million from the public sector were notified.

Importance of Private Sector Engagement:

  • According to WHO, “A staggering one million TB cases are missing from notification, most of them being diagnosed and treated in the private sector. That makes the engagement with the private sector so vital.”
  • The National Strategic Plan also makes the same point about the missing cases in the private sector: “Hundreds of thousands of people with TB disease remain missing to TB surveillance/notification and services, and are likely in private health delivery systems or the community.”
    • It says about 70% of TB patients seek care by private healthcare providers.
    • It had recommended that private provider engagement be rapidly scaled-up to “find and successfully treat two million patients in 2020-2021”.
  • The National TB Prevalence Survey India (2019-2021) found that 50% of TB patients sought care in the private sector.
    • According to it, 63.6% did not seek care for their symptoms, many of those who sought care in the private sector were not notified.
  • Based on the analysis of anti-TB drug sales by pharmacists in India, the private sector was estimated to have treated 2.2 million TB patients in 2014 alone.
    • However, the notifications by the private sector in 2014 were just 0.1 million.

Measures taken by India to eradicate TB:

  • The National Tuberculosis Elimination Programme (NTEP):
    • It aims to strategically reduce TB burden in India by 2025.
  • The National Strategic Plan for TB Elimination:
    • It was launched to achieve the target of ending TB by 2025 in a mission mode.
  • The National Strategic Plan for TB Elimination:
    • It is a multi-pronged approach that focuses on targeting undiagnosed TB in high-risk communities and TB patients seeking care from private healthcare providers in order to discover all TB patients.
  • Ni-kshay Poshan Yojana (NPY):
    • It helps to meet the nutritional requirements of TB patients.
  • Pradhan Mantri TB Mukt Bharat Abhiyaan:
    • It aims to bring together all stakeholders to support individuals undergoing TB treatment.
  • Bedaquiline and Delamanid:
    • These have been made available for elimination of TB.

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