While over half of all tuberculosis (TB) patients seek care in the private sector, case notifications from the private sector are way behind the targets set by the government. While private doctors are reluctant to notify cases, laxity on part of chemists in monitoring the sale of anti-TB drugs that are covered under Schedule H1 of Drugs and Cosmetics Act has also hit the State’s fight against the infectious disease.
In 2021, there were 21.45 lakh new tuberculosis (TB) case notifications in India of which only 6.93 lakh were from the private sector. Karnataka reported 72,636 case notifications that year of which 19,652 were from the private sector.
Although this is a marginal rise from the 17,261 (34% of the 50,000 target) reported in 2020, private notifications have never crossed 37% of the target set by the government.
TB has been a notifiable disease in the country since May 2012. Despite awareness regarding mandatory TB notification, a significant number of private practitioners do not report cases and this has led to cases being missed out of government data. Missing cases who are lost to follow up are one of the prime reasons for quick spread of the infection.
After incentivising private notifications, the Union Health Ministry, for the first time criminalised non-reporting of tuberculosis in early 2018 and as per the government notification, doctors, hospital authorities, chemists and druggists could face a jail term for not notifying TB cases.
State Joint Director (TB) Ramesh Chandra Reddy said while many patients do not want to reveal the infection mainly because of stigma, several private practitioners find reporting a hassle.
“They simply do not report or are forced to do so by patients. Although there is a provision to file criminal cases against those who do not report, it is difficult to implement as it is not possible to prove the charge,” he told The Hindu.
“However, there has been marginal progress in Karnataka. We have intensified collecting drug sale data from chemists and also from Clearing and Forwarding (C and F) agencies. Many chemists are not keeping TB drugs to avoid the hassle of maintaining a register,” he said.
Dr. Reddy said the private notification target for 2022 is being reduced to 35,000. “So far targets were fixed based on population. Now it will be based on prevalence,” he said.
Stigma
Experts said stigma is one of the key reasons for missing cases and those lost to follow up, apart from migration. Many patients often give up treatment because of side effects or as soon as they feel better. This can increase the risk of developing drug-resistant TB which is more difficult and expensive to treat.
“Communities need to understand that TB is curable if treated with the right drugs, dosages and for the right duration of time. We have developed interventions such as community structure engagement, where we enlist the support of key local organizations such as self-help groups to help create awareness in the community and support persons with TB,” said Rehana Begum, who heads “Breaking the Barriers” project (a community engagement initiative to accelerate TB elimination) being implemented in five districts of Karnataka.
Under the project, Patient Support Groups are being created at government health facilities as a platform for persons with TB and caregivers to share their experiences and motivate each other to complete treatment. “Increasing access to treatment also potentially increases notifications and improves treatment adherence and completion,” the doctor added.
