Thursday, May 10, 2012
TB case notification - a remarkable step of Govt. of India
Notification of TB cases is a remarkable decision of Govt. of India and how RNTCP develops the notification system in the coming years is something very interesting to observe.
Presently TB cases outside RNTCP are being reported mainly from the following two sources:
1) Non-RNTCP govt/public sectors (Public-Public Partnership initiative): Those sectors have their own health services like Defense, Railways, Para-Military, Mines, Education etc. Some of these sectors are already reporting TB cases detected by them to RNTCP wherever linkages between these sectors and RNTCP have been developed.
The current policy decision of TB case notification is expected to scale up and strengthen those public-public partnership linkages as TB case notification from non-RNTCP public sector should be comparatively an easier job than the same from non-govt. private sector.
2) Non-govt. sector (Public-Private Mix/PPM initiative): RNTCP is currently linked to Non-govt. sectors through 3 Global Fund supported projects as below:
· Project Axshya/GFATM Round 9 Civil Society project: Linking chiefly unqualified rural practitioners with RNTCP in 374 districts of 23 states
· IMA PPM project/RCC project: Linking the qualified private practitioners who are IMA members with RNTCP in 15 states and 1 UT
· CBCI-CARD project/RCC project: Linking Catholic healthcare facilities with RNTCP in 19 states
· Besides, there are NGO/Private Practitioners’ Schemes of RNTCP that have been engaging Private Doctors and NGOs with RNTCP on individual basis.
But these linkages are not enough as the non-govt. and private sectors providing health services to the people of the country including TB management and care are so vast. It is estimated that about 45% of the TB cases are treated in the private sector.
There is an urgent need to expand the PPM (Public-Private Mix) initiative of RNTCP much beyond the above-mentioned projects and on-going NGO/PP schemes to achieve the two main objectives:
1) To standardize the TB treatment across the country
2) To enhance TB case reporting from all healthcare providers
The policy decision of making TB a notifiable disease should help in achieving the two objectives, provided the policy will be rolled out with proper strategy and approach with clear and simple operational protocol in place that will be accepted by all stakeholders and implementable.
The role of Civil Society will be immense to help RNTCP to achieve its notification objectives. Other than advocacy, Civil Societies can function as an effective interphase between the National Program and private sector to enable and roll out the notification process.
Currently, the National Program is still finding ways to sustain the communication with private sectors as mere one/two time sensitization of the private providers has been found to be grossly insufficient to engage them with RNTCP. The private practitioners should be kept under constant communication and followed up, where the Civil Societies can play a meaningful role, definitely with some kind of external funding assistance or incentives.
Prioritization of the private practitioners according to the volume of TB cases been provided services by them should be an important strategy that RNTCP may consider in coming future to initiate the process of notification.
At the same time the national program should take proper attention and care of sensitive issues like maintaining confidentiality of the TB patients including their HIV status during the notification process.
Let me wholeheartedly congratulate Central TB Division and Govt. of India for taking such strategic and timely decision, especially at a time when the national program has taken the decision to achieve the targets of Universal Access of TB care in the country.
From: Dr Sugata Mukhopadhyay