Latest news with #NationalTBEliminationProgramme
Scoop
16-05-2025
- Health
- Scoop
A For Accountability And Audit For TB Deaths Is Missing In #EndTB Response
This article is an insight from former Chief Scientist of WHO HQ Dr Soumya and others on why TB death audit is necessary so that we can find out the reasons why a person died of a curable disease and avert such tragedies in future. May 15, 2025 When TB is preventable and curable then why over 1.1 million people died of it worldwide in 2023 (as per the latest WHO Global TB Report 2024)? Even one TB death is a death too many. Most of these deaths took place in low- and middle-income countries. Unless we find what went wrong and what could have done better, how would we ever improve TB programmes in order to avert these untimely deaths? A young woman of 19 years old died of TB in Delhi (India). When experts looked at the case, it became evident that it was a failure of the system. This girl was a poor migrant worker. Her father had died of TB. Her sister too had TB. They were seeking healthcare from the private sector and they fell through the cracks. 'Probably, they could not continue the treatment regularly … nobody was tracking them… or following up on them … and by the time she was admitted in LRS Institute (now known as National Institute of Tuberculosis and Respiratory Diseases or NITRD), she had a very extensive bilateral disease and she ended up dying,' said Dr Soumya Swaminathan, Principal Advisor of National TB Elimination Programme, Ministry of Health and Family Welfare, Government of India. Dr Soumya earlier served as Chief Scientist of World Health Organization (WHO) and Director General of Indian Council of Medical Research (ICMR). 'At NITRD they had put her on the ventilator, they did everything possible but could not save her,' said Dr Swaminathan. She was speaking at a special WHO session at World Health Summit regional meeting. A 19-years old girl died in India's national capital Delhi, which has state-of-the-art TB and healthcare infrastructure in public sector too. She died of drug-sensitive TB (which means her TB bacteria was NOT resistant to any TB medicine). 'Such cases are occurring everyday but are we paying attention to that? Are we learning lessons? Are we trying to improve the system?' asks Dr Swaminathan. Despite being curable, TB is the deadliest infectious disease globally TB is the deadliest infectious disease worldwide. It killed more people even during the COVID-19 pandemic in many high-burden TB settings. It mostly impacts the poorest of the poor and the most vulnerable. So, given the inequities and injustices that ail us globally, it becomes less visible to those who are among the privileged few. India is home to the largest number of people with TB globally (2.8 million). WHO Global TB Report 2024 states that 323,200 TB deaths took place in India in 2023, which amounts to almost 900 TB deaths everyday. A for Accountability and A for Audit of every TB death is a must When governments united worldwide to reduce maternal mortality and adopted Millennium Development Goals (MDGs) in 2000, they delivered on it and maternal deaths declined significantly by 2015. 'Reducing maternal mortality had been among the important MDG goals. Governments and communities could deliver on it significantly through certain key interventions- like institutional deliveries and better antenatal and postnatal care, among others. To address the primary causes of maternal mortality, collectors of each district undertook a maternal death audits every month. For every maternal death which occurred, everybody had to sit together and understand and explain why that death was not preventable. Why cannot we have a similar approach to audit TB deaths?' asks Dr Soumya Swaminathan. 'I would suggest that a community medicine department or a public health department of a local medical college in that state be assigned this role to do TB audits. It should not be the TB programme itself doing TB death audit, but it should be presented with the analysis and reasons for TB deaths by those who are doing it,' said Dr Swaminathan. Many countries have made significant progress in reducing TB deaths. But still case fatality rate (number of people who die among those who are diagnosed) is high – it hovers around 10%. For example, in India out of 2.55 million cases that were notified to the TB programme, TB deaths were 323,200 (13%) in 2023. TB death rates are higher for drug-resistant forms of TB. 'China has a TB death rate of 3 per 100,000 population. India has a TB death rate of 22 per 100,000 population,' points out Dr Swaminathan, calling for stronger action to save lives. 'This high mortality for a disease that is treatable is of concern. TB mostly affects people who are in the 25-55 age group, which is an important economically productive one. If we calculate the economic loss to the country because of TB deaths- with people in economically productive age group falling ill and some even dying of TB- then it could be a huge economic burden as well. If we add secondary costs, then it would be way more,' said Dr Swaminathan. 'But more important than economic loss are those individuals who die of a preventable and treatable illness. We must do our best to understand the data and do proper analysis of TB deaths.' Dr Swaminathan shared an example from Tamil Nadu, a southern Indian state where the state government has partnered with National Institute of Epidemiology (an institute of Indian Council of Medical Research) to audit TB deaths and help improve clinical management of TB patients to avert such deaths in future. Dr Swaminathan reflected that people need to get the right care at the right time. They may have TB disease but they also have other conditions, such as severe malnourishment, high blood pressure, diabetes, other co-morbidities, or they come from such a poor background that they cannot access the care they need. TB-related stigma lurks even today which further jeopardises equitable access to care and services. Alcoholism is another major risk factor for TB, she said. 'I have been to hospital wards and seen how people become sick or non-adherent to therapy due to alcoholism.' If we can identify early on, other co-morbidities or conditions a person with TB has then we can perhaps try to tailor our care and services to help and support them finish their TB treatment. She rued that 'Very often hospitals refuse admission for TB patients for one reason or the other.' Hospitals must not refuse admission to needy TB patients. She advises that TB related hospital admission and care should be covered with Indian government health insurance scheme so that hospitals get compensated for admitting and caring for a severely ill person. Once a person is admitted in the hospital then the medical management can try to address specific needs, such as nutritional support, insulin for those with diabetes, help quitting alcoholism, among others. In tribal areas of India, TB patients are more likely to have severe malnutrition and severe anaemia. 'I have looked at death reports from the tribal districts of female patients of 21- 23 years of age have died of drug-sensitive TB with no underlying co-morbidities.' A sincere TB death audit can help us avert such tragedies in future. Dr Swaminathan hopes that in the next National Strategic Plan to end TB of government of India, we would find these gaps that put people at risk of TB death and address them effectively. We also need to have a similar approach in other southeast Asian countries as well, she said. 'Reducing TB mortality significantly can be achieved.' Learnings must come from people on the ground 'Learnings must come from people on the ground, such as, district TB officers, treatment supervisors, laboratory supervisors, TB health visitors, ASHAs (India's voluntary female health workers formally called Accredited Social Health Activists), and of course the patients themselves – as they are the ones who can actually tell you what works well and what does not. We have to make it a point to have a forum where their voices are heard so that we can improve the way in which the programme is designed,' suggests Dr Swaminathan. In India, Humana People to People India developed a model to care for those among the urban poor in 4 major cities of India. Humana's trained and supported team of frontline healthcare workers reached out regularly to homeless and migrant people in Delhi, Hyderabad, Kolkata and peri-urban Mumbai, screened people for TB, supported those with TB symptoms to get an X-Ray and TB test done and seek treatment from the nearest government-run TB centre. Humana's team followed up with each patient every day, and addressed their needs and problems which they encountered during the therapy. For example, encouraging them to stay away from alcohol, providing them nutritional and counselling support, helping those who were too weak to 'even lift a glass or walk' to reach healthcare centres, coordinate with TB healthcare workers regarding treatment followup and help them get cured. Humana's model encourages people who were at heightened TB risk to take charge of their own lives, and seek healthcare and social support services (such as, nutritional or monetary support provided by the government of India or shelters for homeless). Supporting those who are at highest TB risk- especially those who live in most marginalised and vulnerable situations- so that they can get diagnosed early, seek effective treatment, and access support – so that they can finish their TB therapy, is vital if we are to end TB. Models like those developed by Humana People to People India (and proven to work) must be implemented in all high TB burden settings. Despite progress, a lot more needs to be done with urgency Dr Vineet Bhatia, World Health Organization (WHO) Regional Advisor for TB for South-East Asian region, emphasises that access to TB services is critical towards achieving universal health coverage. 'Social protection measures such as cash transfers and nutritional support are essential for mitigating the social and economic impacts of TB. TB should be prioritised in national budgets, including through innovative financing mechanisms, such as social impact bonds and public private partnerships.' Dr Bhatia stresses upon the importance of meaningful community engagement and empowerment which should guide the designing, implementation and monitoring of TB programmes. Dr Bhatia enumerated several examples where countries in South-East Asian region have demonstrated leadership and political will to end TB. Bangladesh hosted WHO's 1st Global Forum on Advancing Multisectoral and Multistakeholder Engagement and Accountability to End TB in June 2024, India has made a foundational shift based on science and evidence to find all TB by screening everyone among high risk people and offering upfront molecular test diagnosis and linkage to care, as part of its 100 Days campaign and extending it to all districts nationwide. Indonesia's Presidential Decree on TB aims to implement a comprehensive strategy towards ending TB. Maldives has rolled out TB-free initiative. Myanmar was the only high TB burden country in South-East Asian region to achieve 2020 milestones for TB incidence decline. Nepal's TB free initiative at Palika-level aims at actively engaging subnational level systems in TB programmes. Thailand has made significant efforts to improve coverage for TB services under its commitment to achieve universal health coverage. Timor-Leste initiated a Partners' Pledge to end TB led by the Prime Minister of Timor-Leste for a multi-sectoral approach. South-East Asia region of the WHO is home to around 5 million people with TB (45% of all people with TB worldwide). The region also accounted 600,000 TB deaths – more than half of all TB deaths globally in 2023. 'While a lot is being done a lot more needs to be done and with urgency' rightly said Dr Bhatia. 'It is time to transform all our commitments and political declarations into actions. We need to accelerate efforts to achieve the global TB goals.' Shobha Shukla – CNS (Citizen News Service) (Shobha Shukla is the award-winning founding Managing Editor and Executive Director of CNS (Citizen News Service) and is a feminist, health and development justice advocate. She is a former senior Physics faculty of prestigious Loreto Convent College and current Coordinator of Asia Pacific Regional Media Alliance for Health and Development (APCAT Media) and Chairperson of Global AMR Media Alliance (GAMA received AMR One Health Emerging Leaders and Outstanding Talents Award 2024). She also coordinates SHE & Rights initiative (Sexual health with equity & rights). Follow her on Twitter @shobha1shukla or read her writings here
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Business Standard
14-05-2025
- Health
- Business Standard
PM Modi calls for scaling up early detection to eliminate TB by 2025
Prime Minister Narendra Modi on Tuesday called for scaling up targeted interventions and successful strategies in early detection to eliminate tuberculosis (TB), while chairing a high-level meeting to review progress under the National TB Elimination Programme (NTEP). This comes even as India has set 2025 as its target year for TB elimination—five years ahead of the Sustainable Development Goals (SDG) target of 2030. The Prime Minister highlighted the need to analyse the trends of TB patients based on urban or rural areas and their occupations. 'This will help identify groups that need early testing and treatment, especially workers in construction, mining, textile mills, and similar fields,' he said. Emphasising the improvement of technology in healthcare, PM Modi called upon Ni-kshay Mitras, or volunteers who support TB patients, to use technology to connect with patients and help them understand the disease and its treatment using interactive and easy-to-use methods. According to the World Health Organization's (WHO's) Global Tuberculosis Report 2024, India tops the list of 30 high-burden TB countries, accounting for 26 per cent of the global TB burden. The same report, however, also points to an 18 per cent reduction in TB incidence in India—from 237 to 195 per 100,000 population—between 2015 and 2023, which is nearly double the global pace of around 9 per cent. It also indicates that TB mortality in India fell by 21 per cent, while treatment coverage rose to 85 per cent. The PM also reviewed key infrastructure enhancements under the NTEP, which included the expansion of the TB diagnostic network to 8,540 Nucleic Acid Amplification Testing (NAAT) labs, 87 culture and drug susceptibility labs, and over 26,700 X-ray units. These include 500 AI-enabled handheld X-ray devices, with another 1,000 in the pipeline. Officials also presented updates on new initiatives such as a shorter treatment regimen for drug-resistant TB, newer indigenous molecular diagnostics, and nutrition interventions under the PM Ni-kshay scheme. Launched in 2018, the scheme provides financial support to TB patients through direct benefit payments of Rs 1,000 per month to help them afford nutritious food during their treatment. 'Under the initiative, 2.94 million food baskets have been distributed by 255,000 Ni-kshay Mitras,' a statement by the Prime Minister's Office said. The recently concluded 100-day TB Mukt Bharat Abhiyaan, which screened 129.7 million people in 445 high-focus and aspirational districts across India, was also discussed in the meeting. According to data from the Union Health Ministry, the campaign led to the detection of around 719,000 new TB cases, of which 285,000 were asymptomatic.
Indian Express
13-05-2025
- Health
- Indian Express
Need ‘whole of govt, society' approach to eliminate TB: PM Modi
Reaffirming India's commitment to eliminate tuberculosis, PM Narendra Modi Tuesday called for a 'whole-of-government' and 'whole-of-society' approach to scaling up the successful strategies nationwide. Chairing a meeting to review status of National TB Elimination Programme (NTEP), the PM stressed the need to analyse the trends of TB cases in urban or rural areas and based on people's occupations. This, he said, will help identify groups that need early testing and treatment, especially workers in construction, mining, textile mills and similar fields. The PM also highlighted the importance of cleanliness through Jan Bhagidari (community participation) as a key step in eliminating the disease. India has set a target for eliminating TB by 2025-end, five years ahead of the global goal. The global End TB Strategy for 2030 says that countries must reduce the number of TB deaths by 90% and new cases by 80% as compared to the levels in 2015. Towards this goal, the Centre last December launched a 100-day TB Mukt Bharat Abhiyaan in 347 priority districts. Under this campaign, health workers looked for TB cases among vulnerable individuals such as household contacts of TB patients, under-nourished individuals, those living with HIV, diabetics, smokers and alcoholics, among others. Over 12.9 crore vulnerable individuals were screened and 7.19 lakh new TB cases detected, including 2.85 lakh asymptomatic patients. The 100-day campaign would further close the gap between the estimated number of TB patients and reported cases. According to the latest available Global TB report, in 2023, of its estimated 28 lakh cases, India reported 25.2 lakh cases. According to officials in the know of the matter, several technologies and methods tried out during the campaign would be implemented across the country. Training was underway, they said. One of the key innovations utilised during the campaign — which helped in detecting several of the asymptomatic patients — was the AI driven hand-held X-ray machines. These machines used AI to read the X-rays without a doctor, meaning these tests could be done by minimally trained health workers. Another key method was Jan Bhagidari — the participation of parliamentarians, Assembly members, local government representatives, officials and members of the public. During the meeting, Modi was informed that over 1 lakh new Nikshay Mitras — who provide nutritional support to TB patients during treatment — had augmented the campaign, along with `1,000 support from government.
The Hindu
13-05-2025
- Health
- The Hindu
PM Modi calls for targeted interventions in TB elimination efforts
Prime Minister Narendra Modi on Tuesday (May 13, 2025) underscored the importance of targeted interventions and technology-led outreach in the fight against tuberculosis, while chairing a high-level review meeting on the National TB Elimination Programme (NTEP) at his official residence. The Prime Minister emphasised the need to analyse TB patient data based on urban-rural distinctions and occupational categories. 'This will help identify vulnerable groups requiring early testing and treatment, especially workers in construction, mining, textile and other high-risk sectors,' Mr. Modi observed. Highlighting the curability of TB with regular treatment, the Prime Minister said the public must be made more aware, with less fear and more support. He called upon Nikshay Mitra —volunteers who support TB patients, to leverage digital platforms and interactive technologies to engage with patients effectively. He reiterated the role of public participation (Jan Bhagidari) and cleanliness in the elimination strategy, and stressed the importance of ensuring that each patient receives uninterrupted treatment. During the meeting, the Prime Minister reviewed encouraging data from the World Health Organization's Global TB Report 2024, which notes an 18% reduction in TB incidence in India - from 237 to 195 per lakh population between 2015 and 2023 - double the global pace. TB mortality in India fell by 21%, and treatment coverage rose to 85%. Officials also presented updates on key infrastructure enhancements under NTEP, including the expansion of the TB diagnostic network to 8,540 NAAT (Nucleic Acid Amplification Testing) laboratories and 87 culture and drug susceptibility testing labs. The current diagnostic infrastructure includes over 26,700 X-ray units, with 500 AI-enabled handheld devices already deployed and an additional 1,000 in the pipeline. The decentralisation of TB services - free screening, diagnosis, treatment, and nutritional support - through Ayushman Arogya Mandirs was highlighted as a cornerstone of the programme's outreach. New initiatives introduced in recent months include shorter drug regimens for drug-resistant TB, indigenous molecular diagnostics, nutrition interventions, and screening in high-risk congregate settings such as mines, construction sites, urban slums and tea gardens. Since 2018, the Ni-kshay Poshan Yojana has facilitated Direct Benefit Transfer payments to 1.28 crore TB patients, with the incentive amount raised to ₹1,000 in 2024. Under the Nikshay Mitra initiative, 2.55 lakh volunteers have distributed 29.4 lakh nutrition baskets to patients. The Prime Minister called for scaling up successful strategies nationwide and reaffirmed India's commitment to eliminating TB. The meeting also reviewed the 100-Day TB Mukt Bharat Abhiyaan, which screened 12.97 crore individuals in high-focus districts, resulting in the detection of 7.19 lakh TB cases - including 2.85 lakh asymptomatic patients. Over 1 lakh new Nikshay Mitra joined the effort during the campaign. Union Health Minister Jagat Prakash Nadda, Principal Secretary to the Prime Minister Dr. P.K. Mishra, and other senior officials were present at the meeting.
News18
13-05-2025
- Health
- News18
PM Modi Chairs Meeting To Review Progress Of Tuberculosis Elimination Campaign
Agency: PTI Last Updated: The meeting was attended by Union Health Minister JP Nadda, Health Secretary Punya Salila Srivastava, and senior officials from the Prime Minister's Office Prime Minister Narendra Modi on Tuesday called for strengthening people's participation to drive a 'whole-of-government" and 'whole-of-society " approach to eliminate tuberculosis. Chairing a high-level review meeting on the National TB Elimination Programme (NTEP), he lauded early detection and treatment of tuberculosis (TB) patients in 2024 and said it should be scaled up nationwide, according to a statement. He reaffirmed India's commitment to eliminating TB from the country. The prime minister reviewed the recently-concluded 100-day TB Mukt Bharat Abhiyaan, covering high-focus districts, during which 12.97 crore vulnerable individuals were screened and 7.19 lakh cases, including 2.85 lakh asymptomatic, detected. Modi stressed the need to analyse the trends of TB patients based on urban or rural areas as well as their occupations. This will help identify groups that need early testing and treatment, especially workers in construction, mining, textile mills and similar fields, according to the statement. As healthcare technology improves, Nikshay Mitras (supporters of TB patients) should be encouraged to use technology to connect with TB patients. They can help patients understand the disease and its treatment using interactive and easy-to-use technology, Modi said. The prime minister said that since TB had become curable with regular treatment, there should be less fear and more awareness among the public. He highlighted the importance of cleanliness through Jan Bhagidari as a key step in eliminating TB. During the review meeting, Modi noted the encouraging findings of the WHO Global TB Report, 2024, that affirmed an 18 per cent reduction in TB incidence (from 237 to 195 per lakh population between 2015 and 2023) at double the global pace, 21 per cent decline in TB mortality (from 28 to 22 per lakh population), and 85 per cent treatment coverage, reflecting the programme's growing reach and effectiveness. He reviewed key infrastructure enhancements, including expansion of the TB diagnostic network to 8,540 NAAT (Nucleic Acid Amplification Testing) labs and 87 culture and drug susceptibility labs, more than 26,700 X-ray units, including 500 artificial intelligence-enabled handheld devices, with another 1,000 in the pipeline. The decentralisation of all TB services, including free screening, diagnosis, treatment and nutrition support at Ayushman Arogya Mandirs was also highlighted, according to the statement. Several new initiatives such as artificial intelligence-driven handheld X-rays for screening, shorter treatment regimen for drug-resistant TB, newer indigenous molecular diagnostics, nutrition interventions and screening and early detection in congregate settings such as mines, tea gardens and construction sites were highlighted. Union Health Minister JP Nadda; Principal Secretary to the Prime Minister, PK Mishra; Principal Secretary-2 to the Prime Minister, Shaktikanta Das; and Advisor to the Prime Minister, Amit Khare; were among those who attended the meeting. First Published:
