Dr. Sunil Khaparde, Deputy Director General ,Ministry of Health and Family welfare, India recently gave a lecture in the SDM health justice lecture series on inter-sectoral response to end TB, which shows how every sector can help end TB
The SDM Health Justice Lecture is a series of online lecturers talks, exploring inter sectoral solution for specific health problems, named after the mother of Prof. Dr. Rama Kant.
Dr. Khaparde stated that TB and Nutrition; TB is a medical and social problem, those living in slum or buildings without ventilation fuel the spread of TB, so also HIV/AIDS make person more vulnerable to TB. It is beyond health sector and needs inter sectoral response.
27% of TB burden worldwide is in India. HIV/AIDS and MDR. TB highest in India. One of the greatest killer diseases in India is TB, worldwide-they is a shortage of long term funding for TB of about $2 Billion, but 2.5 Million lives additionally have been saved from death from TB worldwide.
Ending TB by 2030, would require inter sector approach of increasing health spending per capital and improving quality health and diagnostic given to everybody. Then we can have reduction of death by 90% and from TB by 95% by 2030 and reduction of death by 80% and from TB by 90% by 2035. They would also be need for universal health coverage and social protection, increase in government expenditure on Health, National Insurance and Social Protection Schemes to reduce medical costs. TB is beyond medical problem.
The challenges involved, include difficulty in involving the private sector, improvement in drug resistant outcome, reach the unreachable in slums, tribal, migrants, vulnerable populations, comorbidities like HIV, Diabetes and Tobacco, Determinants like nutrition, poverty ,overcrowding, poor housing and availability of out of pocket expenses by those suffering from TB. The use of ICT tool for adherence and monitoring and active case finding, winning trust and cooperation of patients.
Policies and programmes should be geared towards reducing out of patient expenditure for TB patients, ranging from cost of Diagnosis, cost of treatment, cost of travel, nutrition, wage loss and moving towards digital treatment support.
For HIV and TB, they should be intensified case findings, intensified screening, CBNAAT for diagnosis, Daily regimen for treatment, Airborne infection control measure, IPT, ICT based adherence support.
Airborne Infection Control (AIC), develop cough corners/counter, staff provided with masks and providing N95 mask to hospital staff in high risk setting.
Effort should be made to prevent TB from spreading to PLHIV, children, those in close contact with infective cases. Also to reach TB patients outside public sector and ensure standard care for TB patients, and all TB patients notified and monitored.