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W ith an estimated 2.8 million new cases a year, India contributes to more than 25% of the world’s Tuberculosis (TB) burden. More than half the TB patients in India seek private medical care.
The current system of treatment of TB is confined to either public hospitals where treatment is given free but in an ambience which may not be welcoming, or in private hospitals where affordability is a major concern but the ambience is more welcoming. Public and private care Government hospitals can offer a standardised clinical algorithm and facilities for contact tracing. Yet, the patients feel that free treatments may not be of optimal quality both with regard to the drug bio-availability and the testing processes.
On the other hand, private practitioners may offer a better ambience and better comforts during treatment, but may not adhere to standardised protocols for treatment. Also, patient monitoring may also be compromised in private hospitals, which do not have the bandwidth to ensure compliance and follow-up. As we stride towards the World Health Organization’s goals of ending TB, we need to think of innovations in TB care — that is, with regard to diagnosis as well as treatment.
To balance the faults of the system, we need a strong and sustained drive to encourage public-private partnerships in the management of TB patients. This not only helps the patients by giving them a choice in treatment options, but also guarantees better outcomes as the patients are more at ease with the process. There is a shared responsibility between the public and private health agencies to ensure compliance and follow-up.
World TB Day The need for universal and equitable health coverage Imagining a 360° and comprehensive TB care response Meghalaya re-skills TB survivors, seeks their help as ‘TB champions’ India needs pulmonary rehabilitation in primary healthcare centres to combat post-tuberculosis lung sequelae: experts Women in MNCs at greater risk of TB due to work stress and poor nutrition: Experts TB and women: why gender matters more than ever Meaningfully engaged communities are the key to ending TB This modified paradigm of healthcare delivery, which incorporates the best of both worlds, is probably the answer to TB elimination. This offers a choice in services for the patient without compromising on the outcomes. Diagnostic pathways should be clearly defined through evidence-based protocols, limiting individual variations and compromised conclusions.
This can be applied in both public and private health care delivery. Availability of medicines Certain anti-TB medicines for drug-resistant TB are available only in government hospitals, to limit misuse and prevent resistance development to these novel drugs. To ensure strict adherence to treatment protocols, public health policies insist on admission to hospitals for two weeks at initiation of this regimen for drug-resistant cases.
This can be cumbersome for patients who would benefit from the use of these novel medicines but are not willing to be admitted in government hospitals. Follow-up of patients is optimal in government hospitals where free medicines are given and patients can access social workers when in need. Hence, a collaboration between the two systems with flexibility in care pathways and access to medicines, while reiterating that the basic diagnostic and treatment tenets are not compromised, will benefit patients.
The way forward The problems of establishing contact and ensuring smooth transition of patient care should be addressed. Issues on accountability have to be established. The logistics of cooperation need to be better defined to ensure that patients do not slip through the cracks in the system.
There are issues of unregistered practitioners treating TB. We need a system that warrants that the diagnosis is made based on standard definitions and testing methods. There must be regulation of supply of drugs, adherence to drug administration protocols, and optimal follow-up.
The future of TB treatment should involve the regulation of laboratories. Clinical details should accompany submission of specimens for TB testing. All TB diagnostic test results should be reported to a cell which can coordinate and monitor the results.
There should also be systems to monitor pharmacies which sell TB medicines and give feedback to treating doctors through an expert committee. There is no single way for success. Re-imagining partnerships, disrupting accepted norms, and reframing problems can all offer better directions and pathways for success in TB control.
V. Ramasubramanian is Consultant, Infectious Diseases, Apollo Hospital Published - March 24, 2025 12:12 am IST Copy link Email Facebook Twitter Telegram LinkedIn WhatsApp Reddit tuberculosis / government health care.
