Governments, Public-private Partnership's Role In Reducing TB In India

Policymakers have a pivotal part in influencing the masses and constructing impactful healthcare and services strategies. They can to a large extent stimulus individuals’ attitudes towards the stigma around the disease as they are considered to be thought leaders and authentic sources of information. According to the Union Health Ministry’s data, there were 1.8 million Tuberculosis cases in India in the year 2020.  

The WHO described the public-private partnership as public sector initiatives with the participation of the private sector, where the government organisation is drafting the rules and schemes and the private entity is operating as per the guidelines. Public-Private Partnership or PPP in the context of the health sector is a tool for improving the health of the population. The main reason for the decline of maternal and infant mortality and success of health care delivery in Tamil Nadu and Kerala can is not only on account of the Public Health System but private sector has also provided useful contribution in improving health care provision.

The Ministry of Health and Family Welfare, Government of India, has from time to time came up with the guidelines for PPP in different National Health Programmes like RMNCH+A, NTBCP, NPCDCS, RNTCP, NBCP, NLEP, etc. However, States have varied experiences of implementation and success of these initiatives, therefore the need is to implement the successful models.  

Diagnosing the “missing millions” is a colossal obstacle in achieving the goal of eradicating tuberculosis by 2030. The estimated 4.3 million people who are not registered with the Indian healthcare structure has an additional one million missing from their database. TB diagnosing is actually turning to be challenging due to duopoly of Truenat and GeneXpert, first is due to the difficulty in obtaining appropriate clinical sample, especially from the non-reachable sites and secondly due to the poor sensitivity of diagnostic tests. An example of GeneXpert was given which has very poor detection rate of TB in ascitic and pleural fluids.  

However, India managed to diagnose 700 thousand Tuberculosis patients last year. This was possible because of the incentives provided to the doctors, patients getting nutrition support, amplification of diagnostic system and introduction of legal punishments for non-notifications of TB patients by the private sector. The Indian government has even proposed ₹500 per TB patient per month for ensuring that they are having proper nutrition under the Revised National Tuberculosis Control Programme (RNTCP). The ministry drafted the nutritional care guidelines for TB patients, which encompasses instruction on nutritional assessment, correct dietary advice and counselling. The programme also enables the TB patients to leverage various state government’s social support actions.  

PPP’s multi-pronged approach will help in finding the missing million. It also aims to reach out to all of the TB patients seeking care from private service providers, and might not be getting adequate treatment. The partnership also wants to tap into the undiagnosed citizens who face problems in availing diagnostic residing in remote locations and those who are at the last mile with high risk of encountering TB and no. 

Proper implementation of PPP can only happen if both the stakeholders are aligned towards mobilising adequate resources and strengthening the healthcare infrastructure. Our country’s healthcare inequities like maintenance of buildings, utilities, housekeeping, meals, medicine stores, diagnostic facilities, transport, security, communications etc can be tackled via: 

• Developing structured mechanisms for clinically vulnerable segments such as TB-Diabetes, TB-Tobacco and TB-HIV.  

• ICT and Financial interventions for streamlining and smoothening of the program. 

• Eliminating the indifference of the private sector towards public health actions to control TB. 

• Building civil society for better advocacy to increase accountability. 

• Enhancing the supply chain components to ensure the uninterrupted supply of TB drugs, including creating a supportive environment for a sustainable supply chain. 

• Improving the knowledge base on links among incentives, productivity, and quality TB services in the private sector. 

• Financing the TB programme- Increasing public and private domestic resources for TB control services and catalysing private sector investment in TB control using public-private partnerships. 

• Ramping up efforts to accelerate the process of detection of TB that’s been slowed down due to Pandemic. 

The magnification of tuberculosis care and prevention across the health sector is likely to happen only if sufficient amount of funds is raised. The strategic plans should be properly budgeted with clear identification of gaps and challenges. A well-budgeted plan should facilitate resource mobilisation from diverse sources for full implementation of the plan. 

There needs to be continuous supervision and training of the medical professionals are necessary for sustaining notably expanded activities related to Tuberculosis prevention and care. Central coordination under government stewardship is essential. The first step for obtaining this is developing a national strategic plan considering the epidemiology, healthcare system, resource availability, regulator policies, supply chain and coordination with all stakeholders. Then this scheme could be embedded in the national health sector plan. 

For ending the tuberculosis epidemic, we would require building a lasting partnership across the health and other social organisations, which would endow transparency, integrating community-based TB care and efficiency while dealing with and treating the TB cases.  

Dr. Praveen Aggarwal

Guest Author Director & Co-founder at Consocia Advisory

Dr. Manorama Bakshi

Guest Author Head - Public Health & Advocacy at Consocia Advisory