dbt can help tb elim­i­na­tion

Governance Now - - CONTENTS - ar­chana@gov­er­nan­cenow.com

Dr Su­nil Kha­parde of the health min­istry’s TB pro­gramme on the ben­e­fits of DBT for treat­ment of the dis­ease

Close to 1,400 lives are lost to tu­ber­cu­lo­sis ev­ery day in In­dia. The gov­ern­ment has set it­self the tar­get of mak­ing In­dia Tb-free by 2025, un­der ‘Na­tional Strate­gic Plan for Tu­ber­cu­lo­sis Elim­i­na­tion 2017-25’. This would in­volve pro­vid­ing not just medicine to the needy, but also money so that they can buy nu­tri­tional food – a must in the treat­ment. The health min­istry now plans to de­ploy the Aadhaar-linked di­rect ben­e­fit trans­fer (DBT) to reach out to the gen­uine pa­tients and avoid ghost ben­e­fi­cia­ries. Un­der the Re­vised Na­tional TB Con­trol Pro­gramme (RNTCP), mon­e­tary ben­e­fits to tribal pa­tients and health work­ers who no­tify TB cases will be paid through DBT now. It has asked the state to give top pri­or­ity to up­dat­ing Aadhaar num­bers and bank ac­count de­tails of all TB pa­tients and care providers so that the DBT mode can be rolled out be­fore the 2025 plan comes into force. Ar­chana Mishra talks to deputy direc­tor gen­eral (tu­ber­cu­lo­sis) Dr Su­nil D Kha­parde on the ben­e­fits of DBT in TB treat­ment.

How will Aadhaar and di­rect ben­e­fit trans­fer (DBT) help TB pa­tients?

DBT is an am­bi­tious plan of the prime min­is­ter. in tribal ar­eas, un­der the ex­ist­ing TB pro­gramme an in­cen­tive of ₹750 is al­ready be­ing given to TB pa­tients and ₹250 to ser­vice providers for no­ti­fi­ca­tion and ₹500 for fol­low-up. The money is given through cheques. DBT in the TB pro­gramme will help di­rectly trans­fer the money in the bank ac­counts of ser­vice providers and pa­tients.

For this Aadhaar is manda­tory to iden­tify the per­son and avoid du­pli­ca­tion of ben­e­fi­cia­ries. RNTCP has de­vel­oped a mech­a­nism called nikshay (an in­ter­net-based mon­i­tor­ing mech­a­nism) where all cases are reg­is­tered and no­ti­fied. The DBT will be given to those linked to nikshay. This DBT mech­a­nism is needed be­fore we im­ple­ment the na­tional strate­gic Plan for Tu­ber­cu­lo­sis elim­i­na­tion 201725 which pro­poses more fund­ing and newer ini­tia­tives for TB pa­tients. The plan is to pro­vide money to not only trib­als but all poor TB pa­tients. The amount is wage loss com­pen­sa­tion and a sup­port sys­tem to pro­vide nu­tri­tious food.

Sev­eral NGOS work­ing in tribal ar­eas of Ch­hat­tis­garh and Mad­hya Pradesh told us that they were not aware of tribal TB pa­tients get­ting any mon­e­tary help, though ser­vice providers do get it. Why so?

it is not pop­u­larised by states. schemes are there but af­ter all the money has to be utilised by the state gov­ern­ment. some states have used it and some have not. Also ₹750 for the en­tire treat­ment is a small amount.

There are cer­tain states which are al­ready run­ning their own TB pro­grammes. Will DBT ap­ply to those schemes too?

We have de­vel­oped the mech­a­nism. some tri­als and pi­lot projects have al­ready been con­ducted. if we link ben­e­fi­cia­ries’ Aadhaar with Nikshay, pa­tients can be very well iden­ti­fied. There will be no du­pli­ca­tion of ser­vices. The cen­tre is just propos­ing to give ₹500 per pa­tient per month un­der the strate­gic plan to com­pen­sate wage loss and give nu­tri­tional food sup­port. We can give medicine but we can­not en­sure their nu­tri­tion. That is not the doc­tor’s or health min­istry’s task. There­fore, we are even think­ing of link­ing the scheme with PDS [pub­lic dis­tri­bu­tion sys­tem]. We are also look­ing at other plat­forms like an­gan­wadis to help TB pa­tients in get­ting nu­tri­tional food. TB is not just a health prob­lem but also a so­cial prob­lem. if we re­ally want to elim­i­nate TB we need in­ter-sec­toral co­or­di­na­tion.

What hap­pens if a TB pa­tient with the Aadhaar card is not reg­is­tered in Nikshay? Is there any mech­a­nism to check that no TB pa­tient is left out in this process?

once a case is reg­is­tered with nikshay, it means the gov­ern­ment is no­ti­fied about the pa­tient. it is the re­spon­si­bil­ity of our dis­trict level of­fi­cer or pri­vate clinic/hos­pi­tal to en­sure that de­tails of all TB pa­tients are fed prop­erly in nikshay. in gov­ern­ment hos­pi­tals the list is with the dis­trict of­fi­cer and

they are al­ready no­ti­fy­ing to nikshay. Today, 70 lakh cases are on the por­tal. We are also do­ing ac­tive case find­ing and no­ti­fy­ing them. it is an im­por­tant as­pect be­cause only then we can take proper ac­tions. Af­ter no­ti­fi­ca­tion, the next step is ver­i­fi­ca­tion. From pub­lic hos­pi­tals there is 95 per­cent re­port­ing.

As for pri­vate hos­pi­tals, there are com­plaints of un­der-re­port­ing.

since ages we have been ask­ing pri­vate hos­pi­tals for proper no­ti­fi­ca­tion of TB pa­tients. They should di­rectly feed the data on nikshay or can pro­vide the in­for­ma­tion to the nodal of­fi­cer. The pri­vate sec­tor is the main pil­lar of the strate­gic plan. With­out its sup­port we can­not con­trol or elim­i­nate TB. only 15 per­cent cases are re­ported by the pri­vate sec­tor and about 60 per­cent pa­tients are go­ing to them. We want to re­duce this gap. But we know the progress will be slow. in 2014-15 only one to two per­cent cases were re­ported by pri­vate hos­pi­tals; now the num­ber has reached 15 per­cent. dur­ing the last three-four years we have done var­i­ous pi­lots in Mum­bai and Mehsana [gu­jarat]. We have de­vel­oped a strat­egy to give free TB di­ag­nos­tics and drugs to the pri­vate sec­tor. Through this they can align with the gov­ern­ment pro­gramme.

How is the health min­istry try­ing to bring pri­vate play­ers on board?

if we are giv­ing free drugs to the hos­pi­tal, we want them to no­tify new pa­tients to us. cur­rently, we are just con­vinc­ing the doc­tor to no­tify us for the in­ter­est of the na­tion. it will take time. if they don’t, strict laws should be made that en­sure man­date no­ti­fi­ca­tion and puni­tive ac­tion against de­fault­ers. only af­ter penal­ties are im­posed in one or two cases can we ex­pect changes. We are try­ing to con­vince them and sen­si­tis­ing them about treat­ment pro­to­cols through IMA and other in­ter­face agen­cies.

in the strat­egy plan we are look­ing at de­vel­op­ing some in­ter­face agen­cies be­tween the gov­ern­ment, com­mu­nity and pri­vate sec­tor. They will help en­sure that al­ready no­ti­fied pa­tient should get free drugs and di­ag­nos­tics.

The Bhore com­mit­tee re­port of 1946 out­lined two ma­jor fronts on which TB needs to be fought – the so­cioe­co­nomic do­main of In­dian life and di­rect at­tack on the dis­ease through medicines. Where do we stand now?

We have fac­tored in all this in the strate­gic plan. A con­certed ef­fort is re­quired from ev­ery­one. it is not the sole re­spon­si­bil­ity of the gov­ern­ment. The gov­ern­ment can act as an en­abler, cre­ate an en­vi­ron­ment. in the sdg goals 2030 health is just a small part. There are big­ger goals like hunger, food, agri­cul­ture, gen­der and ed­u­ca­tion which will have an im­pact on over­all health. TB is driven by poverty. With growth and de­vel­op­ment, TB will de­cline. it was once ram­pant in europe but as its econ­omy im­proved, the in­ci­dence came down.

Gn photo

Newspapers in English

Newspapers from India

© PressReader. All rights reserved.