Health and Development Initiative-India, (www.healthinitiative.org), publishes ‘TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India.

Editorial note:  

Network for Action on TB and Poverty

“Friends, to win the battle against TB, we also have to win the battle against poverty. There is a close link between poverty and disease, and this is true about TB also. Malnutrition, congested living conditions, and unhealthy working environments predispose the poor to this killer disease. We have to remove these disease-breeding conditions by improving the quality of life of the poor and weaker sections in our society.” – Atal Bihari Vajpayee, Prime Minister of India

The relationship between TB and poverty has been explored in depth as a result the 2002 World TB Day theme “Stop TB-Fight poverty”. We have been able to identify the constraints and obstacles that poor people face while trying to access treatment for TB. These barriers must be eliminated if the TB control programmes have to succeed. However, this would require concerted and coordinated efforts by TB and poverty experts with different backgrounds.

The decision of the Coordinating Board of the Stop TB Partnership to set up a Network for Action on TB and Poverty is a step in the right direction. It is hoped that this network will become a platform for innovative implementation and sharing of experiences. It is encouraging to note that the Coordinating Board has decided to set up the Secretariat for the Network in a developing country. This will help the Network, which is going in for a phased expansion of its activities, to seek greater participation of policy makers, NGOs, women and the poor.

The Network bodes well for a country like India, which is burdened with one third of global TB load and has 26% of its population living below the poverty line. India needs support and help from all quarters in its battle both with TB and poverty.
 

Prime Minister reaffirms his pledge to fight TB to the finish
 

A committed political leadership supports TB control initiatives in India. The presence of Prime Minister and Union Health Minister at the inaugural function of Second Stop TB Partners’ Forum sent out a clear signal that Government of India is determined to fight TB to the finish.

Mr. Atal Bihari Vajpayee assured the delegates assembled at the Second Stop TB Partners’ Forum in New Delhi on World TB day 2004, the Prime Minister of India declared, “I am also a partner with you in this war on TB – both as a person and, of course, as India’s Prime Minister.”

He said that there was no room for complacency in India’s renewed fight against TB and low case detection rates and non-adherence to treatment, which plagued TB control programme in the past, were simply unacceptable.

He advised TB control programme managers to take the programme beyond government ministries and launch an aggressive awareness drive to generate demand for DOTS in the community.

Full text of Prime Minister’s speech is available at: http://pmindia.nic.in/lspeech.asp?id=541

Indian Business Alliance to Stop TB

The World Economic Forum’s Global Health Initiative has brought together seven top Indian businesses and the public sector to work together to stop tuberculosis in India. Specifically, this alliance of companies will implement the Revised National TB Control Programme (RNTCP) for their workers and families in collaboration with the Indian Government.

The Alliance launched on WTBD comprises the Global Health Initiative, RNTCP, the Confederation of Indian Industry, WHO and the Global Partnership to Stop TB. The companies involved are Aditya Birla, Larsen Toubro, Lupin Ltd, Modicare Foundation, Novartis India, Reliance Industries, Tata Steel and Triveni Sugar. These companies together cover a population of 3.5 million and have publicly committed to control TB in India.

The aim of the "Indian Business Alliance to Stop TB" is to tackle tuberculosis in an area where it can cause the most harm -- closed workplaces, and also eliminate the attached stigma and lack of awareness about TB.

Related story: India's Public, Private Sectors Unite Against TB Click here for the story

In Haryana, shoemaker leads war against TB

(By Toufiq Rashid, Express News Service, dated 29th March 2004)

It’s an unlikely battleground in India’s fight against TB; a disease that Prime Minister Vajpayee recently said poses a serious threat to the country’s progress and well-being. Bansi Lal is an unlikely warrior.

But try telling him that. A shoemaker who lost his father to the disease and saw his brother struggle against it has turned a small room in his run-down double-storey house in Karnal’s (a city in north Indian state of Haryana) Sadar Bazaar area into a TB clinic for nearly 110 patients. After having joined as a community volunteer in the tuberculosis control programme of the Government a year ago, he has put 50 patients on the path to recovery.

Lal decided to join the war against TB, for which he takes no remuneration, after his younger brother contracted and survived the disease. ‘‘My father died of it and my brother also got it. When it happens in the family, you realize how fatal it is,’’ he says.

Everyday TB patients from nearby houses line up outside Lal’s house to take their daily dose of medicine. If the queue gets too long, his teenage daughter Madhu and his younger brother Mohan Lal pitch in.

Lal is one of the hundreds of volunteers registered as DOTS provider under RNTCP in India. The programme advocates taking help from the community to implement DOTS, wherein a patient is administered medicines under the supervision of a trained person—a doctor or a paramedic.

Explaining the importance of volunteers like Lal, TB in-charge of the district Dr N. Saini says: ‘‘To have each and every TB patient monitored by a doctor is not possible in India as the patient load is very high and the number of doctors very less. So these community volunteers are a great help.’’

Read the full story at: http://www.indianexpress.com/full_story.php?content_id=43966

India Tuberculosis Control Report Card bares RNTCP’s Achilles' heel

India TB control Report Card issued by an international organization, Massive-Effort on WTBD this year has placed Andhra Pradesh, Assam, Bihar, Haryana, Jharkhand, Karnataka, Madhya Pradesh, Orissa, Punjab and Uttar Pradesh in the ‘Failing’ category. These states, which constitute 56% of the Indian population, are curing 30% or less infectious TB cases using Directly Observed Treatment Short course (DOTS). The report card says, “ little or no progress was made in the past year to extend the DOTS treatment services to more people in these states. People living in these states should demand to know why so little progress is being made”.

DOTS services have either just begun or are absent in another 16 states or centrally administered territories, which are home to 5% of population of the country.

The report card places Gujarat, Kerala, Maharashtra, Tamil Nadu and West Bengal in ‘could pass soon’ category for curing 30% to 60% infectious cases using DOTS. Only four states have won distinction for curing 60% or more infectious cases.

Nearly 2 million people became sick with TB last year in India. More than 400,000 died. Say the authors of report card, “ The marks on this report card are not academic. Rather, they are truly a matter of life and death”.

Read the full story at: www.massiveeffort.org

Unlikely heroes in a strained health systems


(HDN Key Correspondents visit a DOTS clinic in center of New Delhi, following Stop TB Partners Forum in March 2004).

Stopping tuberculosis is a daunting task and it takes more than just the DOTS strategy to succeed. It also takes the hidden heroes - the men and women who work in TB centres every day, oftentimes underpaid, overworked and unrecognized.

The moment we entered the New Delhi-based DOTS clinic, it was immediately clear that the center is run by a well-trained staff that care deeply about the men, women and children that are treated for TB there. The clinic is spotless and despite limited resources, is well organized and well cared for. It is also very busy. A display board shows the number of clients visiting the center each month, and the catchments area served by the center - 2 million residents in the densely populated city of Delhi.

Behind the well-trained staff and the well-kept clinic, is the doctor in charge, who has been working in TB control for over 30 years. Initially, he was reluctant to speak to our group of five who had just identified ourselves as participants of the Stop TB Partners Forum. He was unaware there was a Stop TB Forum happening. In fact, he was unaware that there was a Stop TB campaign at all. But he was aware that 30% of all TB cases are found in India and he was aware of the programmatic deficits and resource shortages that are preventing the clinic from operating at an optimum level. His frustration was palpable. He lamented that he has been working in TB control in the capital city of Delhi for three decades yet no one bothered to inform him or the hundreds of health workers who are working with DOTS in TB clinics.

Read the complete story at: http://eforums.healthdev.org/read/?forum=stop-tb
Source: STOP-TB eForum 2004: stop-tb@eforums.healthdev.org

Quacks treating TB patients in slums of Ludhiana

(Shivani Bhakoo, The Tribune, Chandigarh. March 24,2004)

Notwithstanding claims by the Health Department of providing free medicine to tuberculosis patients in the Ludhiana district through their directly observed treatment (DOT), thousands of TB patients living in slum areas near the Buddah Nullah (in industrial town of Ludhiana) are being treated by quacks.

The slum areas adjoining the Buddah Nullah, including Shivpuri, Madhopuri, Guru Nanak Pura, Kundanpuri, Sundernagar, Salem Tabri, Chandernagar, and Bihari Colony are a hub of patients suffering from tuberculosis. But rarely has any health worker for detection or treatment of tuberculosis approached them.

Ram Sirat, a labourer of the migrant Bihari colony, said there were around 500 jhuggis (shanties) in the area. Almost every second person in the colony was suffering from chronic cough, he said.

“I have been living in the colony for the past three years but no health worker has approached us for the detection or treatment of disease. I have been taking medicine for TB from a private practitioner”, he said.

According to sources, even big industrial houses have appointed quacks as their “medical officers”. An industrial worker, on condition of anonymity, said because of lack of awareness and education, the migrant population could easily be fooled by their employers.

Read the complete story at: http://www.tribuneindia.com/2004/20040324/ldh3.htm 

India Launches Free Drug Program but ARV Supplies Inadequate

(San Francisco Chronicle - April 2, 2004)

Down a dark corridor on the ground floor of New Delhi’s Lok Nayak public hospital, Room 32 beckons with a glow of bright lights, fresh paint and the promise of free antiviral drugs for a handful of India's poorest AIDS patients.

Here and at six similar sites in this nation of 1 billion citizens, in April this year, the Indian government took its first tentative steps toward distributing AIDS drugs to 100,000 people.

At the new Lok Nayak AIDS clinic, there are enough drugs for only 200 patients, and doctors launched the program today with medicines for only six. Made of combinations of generic copies of the costly antiviral drugs that prolong the lives of AIDS patients in the United States, the medication will cost the Indian government about $1 a day for each recipient.

During the first phase of the Indian government program, the drugs will be distributed with priority first to mothers who are HIV positive and who participated in a program that gave a short course of drugs to them during childbirth. Although the program can cut in half the number of infants who contract HIV from their mothers, without lifelong treatment, those mothers will eventually die of AIDS. The second priority will be to give the drugs to HIV-positive children who are below the age of 15, and the third priority will go to what the government calls "full-blown AIDS cases”.

Complete story at: http://www.aegis.org/news/sc/2004/SC040402.html 

AIDS Care at TB Clinics in Kolkatta

(The Telegraph Kolkatta, April 6, 2004)

The Kolkatta (Calcutta) Health Department is merging treatment of HIV/AIDS and tuberculosis. The overwhelming number of AIDS patients who are co infected with TB prompted this decision. The HIV/TB treatment program, though in practice already, was officially launched on April 7, 2004, World Health Day. Under this new program, all TB hospitals in the state will admit and treat HIV-positive and AIDS patients who have developed TB symptoms. Beds at the seven TB hospitals in the state, left unoccupied due to success of the DOTS program, will be utilized for the increasing number of AIDS patients who have developed TB.

Source: CDC TB-Related News and Journal Items Weekly Update, April 11 to 17, 2004

Web Call: Stop-TB eForum re-launched

Stop-TB eForum was re-launched on World TB Day 2004. The Forum will aim to provide a platform for debate and advocacy. The importance of multi-stakeholder participation is essential for the control and elimination of TB and the Forum is expected to foster this relationship by identifying new partners and open up fresh avenues to provide the means for raising funds. In order to dispel the myths surrounding the disease it is essential that public awareness be heightened through discussions, these deliberations can be easily generated and resolved through the forum. The forum will thus spearhead the process of TB control and help bridge the communication divide that exists in its many elements.

If you wish to join the Forum, send a blank message to:
join-stop-tb@eforums.healthdev.org 

TBNI Editorial Team

Dr. Dinesh Kumar,
dinesh_kumar@vsnl.com 

Dr. Jatinder Singh,
jatindersingh@vsnl.com