HYDERABAD: Eradication of tuberculosis, by all means, appears to be a priority for the Centre which was recently indicated in the Budget presented by Union Finance Minister Arun Jaitley where he has set a deadline of 2025 for achieveing the same. Closer home, officials of Telangana State Revised National Tuberculosis Control Programme (RNTCP) believe this is an ‘unrealistic’ target. Their main cause of concern is bureaucratic tangles that disturb the inflow of central government’s share of funds.
Thirteen years after it was founded to battle the “tuberculosis emergency” in the country, the agency has been able to achieve only marginal success.
There was a steady decline in the number of fresh TB cases being reported, but this resulted in central level budget cuts from 2013. The trend of budget cuts was for the first time reversed in this year’s budget allocation, with Rs 5,500 crore sanctioned per year until 2019 to fight TB.
But in 2013, the Centre had altered the disbursal of funds to state TB department. “Previously, the budget came directly to the TB department as it is an important emergency programme. The then central government made changes to the process and gave the budget to the treasuries,” said Dr Ch Surya Prakash, additional director, (Planning & Evaluation) and State TB officer.
Once the new arrangement came in, as many as five state government departments got involved in the process of getting the budget released. The files related to the budget keep moving between the departments before it finally got released.
“None of the states are happy about this system. It takes 6 to 12 months for the budget to get released,” said Surya Prakash.
Interest-free loans taken to run smoothly
To ensure the smooth running of the projects under RNTCP, the state TB department now takes interest free loans from the state family and health welfare department.
“We have streamlined the process, the commissioner of health has been very supportive,” said the official.
The central government may want to eradicate TB by 2025, a full ten years before the WHO set a target of 2035. But officials on the ground say this is unrealistic as there is an “iceberg problem”. “From overall, the figures may look like they are declining but that doesn’t solve the problem. There is an iceberg issue where a lot of cases are going unreported,” said Surya Prakash.
If the DOTS (Directly Observed Treatment, Short Course) programme is being used to bring more private practitioners into the fold of notifying the disease, the Nikshaya programme is aimed to facilitate it. But in Telangana, only about 4-5 per cent of private practitioners report TB cases, the national level is just 11 per cent. The health ministry is on a war footing to ensure 100 per cent private sector participation in notification of the disease by 2017 end.
For Nikshaya programme to succeed, there needs to be adequate mobile and internet connectivity, especially in rural areas. The central government has BharatNet’s optical fibre network expected to be completed by 2023 and the Telangana government has their own optical fibre laying project expected to be completed by 2018.
“Many Public Health Care centres have a computer but no internet connection,” said an official. The RNTCP is aware that the data from districts collected through the portal is much lower than what is entered through the hard copy files. With the RNTCP unable to properly gauge how many TB patients are actually out there, the officials feel the 2025 target set by the central government is unrealistic.