India's health minister J. P. Nadda reiterated the country's commitment to eliminate tuberculosis (TB) by 2025 at a WHO ministerial conference on ending TB in Moscow earlier this week. But back home, his ministry seems to be dragging its feet on a policy proposal for TB patients.
According to the latest WHO Global TB Report, India has the highest burden of tuberculosis in the world. To help ease the direct and indirect costs incurred by TB patients, especially those below the poverty line, the National Strategic Plan for Tuberculosis Elimination (2017-2025) proposes a cash benefit of Rs 2,000 per month for those seeking care in public and private sector facilities. An Aadhaar-linked direct benefit transfer, the cash incentive was proposed to ostensibly support the nutritional needs and loss of wages incurred by patients of tuberculosis.
Several months after the proposal, Survivors Against TB, a patient advocacy group wrote a letter to the health minister to "specifically request information on when the scheme is likely to begin" and "when the first set of payments will reach the end beneficiaries.” According to the group, their letter, written on November 1, 2017 has elicited no response from the ministry, raising concerns about the government's commitment to ease the financial burden on TB patients.
"This scheme was conceptualised to ensure that TB would not be a cause of increased debt and poverty for affected families, especially those below the poverty line," said Chapal Mehra, a spokesperson of the group. "By delaying this scheme, the government is denying the bare minimum economic benefits to TB patients to help them survive this disease," he said.
Mehra says that global evidence has also shown that poverty and TB are connected, and those suffering from the disease endure huge financial strain, despite the free drugs and treatment provided by the government. "People who are poor contract TB frequently and experience severe economic barriers to health care, including high expenses as well as loss of income. This scheme would be a game changer for them," Mehra told THE WEEK.
Costs incurred by patients are higher if they have multi-drug resistant TB. Patients of MDR-TB are currently being managed in medical colleges and private sector hospitals. In a study done in Mumbai and published in the International Journal of Science and Research, authors found that the unavailability of drugs on hospital schedule force the patients to buy them on their own.
Thus, the average cost of treating MDR-TB over 24 months comes out to be Rs 1,40,752.50. This includes total drug costs of Rs 1,29,406.17. The average total daily cost of drugs is Rs 166.83, according to the journal article. The average monthly income of the families in the survey was Rs 8,333.33, and they bore the treatment costs with their own funds.
More than half of India's TB patients are being treated in the private sector, posing a challenge in sustaining the treatment, the national draft policy says. "The overwhelming challenge facing TB control in India remains delayed diagnosis and inadequate treatment, particularly among patients seeking care from private providers, who alone are ill-equipped to sustain their patients on prolonged, costly treatment," it says.
Thus, the government has to extend the financial assistance to patients seeking care from the private sector, too, says Mehra. Though the policy draft proposes to provide an incentive to them as well, it does not mention a timeline to do so, he says.
At the Moscow ministerial conference on ending TB, Nadda said that quality of care was the top priority for the government, and this includes "free diagnosis with rapid molecular tests, free treatment with best quality drugs and regimens, financial and nutritional support to patients," among other services.
In that context, Survivors Against TB insists that the government ought to hasten the cash benefit scheme for poor TB patients. The national policy draft also sets an ambitious target to provide the cash incentive to 50 per cent of notified TB patients by 2018. "We have also proposed key parameters for effective monitoring and evaluation of the scheme," said Mehra.
