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Govt. working hard for drug-resistant TB: Health Secretary
The public health officials in India are putting sedulous efforts on drug-resistant tuberculosis (DR-TB) and will find out the short comes very soon, said secretary of Health & Family Welfare Luv Verma today at an ASSOCHAM event held in New Delhi.

"India is highest TB burden country in the world, accounting for nearly one-fourth of the global incidence and in 2012, out of the estimated global annual incidence of 8.7 million TB cases; 2-2.4 million were estimated to have occurred in India," said Luv Verma while addressing the ASSOCHAM'S 'Tuberculosis Awareness, Prevention & Wellness Programme'. 

Verma highlighted the major revised national tuberculosis control programme (RNTCP) achievements, treatment success rates have tripled from 25% in pre-RNTCP era to 88% presently (2012) and TB death rates have been reduced from 29% to 4% during the same period. Inception of the programme has examined more than 144 million TB suspects, also diagnosed more than 18 million TB cases and saved more than 3.2 million lives.

"Since 2007, RNTCP has also achieved the NSP case detection rate of more than 70% in line with the global targets for TB control while maintaining the treatment success rate of >85% as per the 11th five year plan objectives."

"Nearly 3397 NGOs collaborations and 13,525 private practitioners are involved in the programme in different signed schemes under NGO/PP schemes. Over 320 medical colleges (including private ones) have been involved in RNTCP by the end of quarter-3 of 2013", quoted Verma.

"To improve access to tribal and other marginalised groups the programme has developed a Tribal action plan which is being implemented with the provision of additional TB units and DMCs in tribal/ difficult areas, additional staff, compensation for transportation of patient & attendant and higher rate of salary to contractual staff," said Verma.

Dr Nata Menabde, WHO Representative to India said, "India has 26% of the incident TB cases globally. Annually, 1.3 million incident TB cases are notified to the national programme. The patients who access the public health programme get quality assured diagnosis, treatment and public health support required for successful treatment outcomes. However, there are an estimated 2.2 million incident TB cases in India. Hence, there are nearly a million cases missing from notification. This missing million, also more than a third of the TB cases in India, are unable to avail government services as most of them are managed in the private sector."

Dr. Nata further said, there is an urgent need to improve our efforts on prevention and to address the social determinants of health. We must recognize that any efforts in TB control are unlikely to yield the desired results, unless they are accompanied by efforts to reduce TB transmission through improved living conditions, housing, nutrition, and reduction of airborne transmission for a large part of the population.

Secondly, we must recognize that controlling both drug sensitive TB and Drug Resistant TB cannot be done through the public sector alone. We need to stop new infections and essentially "turn the tap off" an entire generation of new drug-resistance cases.

"We have to think innovatively, change our approach and commit ourselves to working with both the formal and non-formal private sector to address this issue. I must reiterate here that our current efforts to prevent the emergence of drug resistance are grossly inadequate", added WHO Representative to India.

It's also important to acknowledge that India has already made a number of bold policy decisions to control TB. These include banning of commercial serology for TB diagnosis following a WHO recommendation, mandatory notification of all TB patients, and including anti-TB drugs under a special drug regulation schedule called H1, thereby restricting their sale only through valid prescriptions etc. These policies reinforce India's commitment to control TB. We also need stronger laws for ensuring accountability of all health care providers for patient's adherence to anti-TB drugs etc. This is particularly crucial for prevention of drug resistance, mentioned Dr. Nata.

"There should also be continued efforts to improve coverage and quality of TB diagnosis and care in order to reach the 1 million "missing cases". This will require significant reforms in the public sector. At the same time, we need to ensure a strong and coordinated engagement of the private sector. Legal frameworks will have to be adjusted, regulatory bodies and measures will have to be significantly strengthened", said Dr. Nata.

We must accept that prevention alone is insufficient and we must, in parallel, put in place systems for early diagnosis and treatment. Ambitious targets like 95% decline in TB death and 90% reduction in TB incidence in 20 years' time will not be possible without new tools such as new effective vaccines, better point of care diagnostic tests, improved drugs and shorter regimens, added Dr. Nata.

Speaking on the occasion, John Beed, Mission Director, USAID India, said "working closely with the Government of India, USAID has been supporting the revised national TB control program over the last 17 years. TB remains a challenge, but the government's efforts have helped reduce the rate of infection and mortality of TB, enabling India to meet the millennium development goals for TB. While there is great work being done, much work remains."

D. S. Rawat, secretary general, ASSOCHAM, said "In India, two deaths occur every three minutes due to TB. Given this, it is critical to bring together various stakeholders who can address the problem on one platform to identify how they can collaborate, and share best practices and successes. ASSOCHAM is privileged to collaborate with CTD and the Ministry of Health and Family Welfare on an awareness and preventive healthcare program for TB. We encourage corporates to join us in this endeavour to provide universal access to diagnosis and treatment for TB to all Indians."

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