India accounts for 27% of the estimated 10 million tuberculosis (TB) cases worldwide, and 26% of the 6.4 million new cases of TB reported in 2017 – making it one of the 30 countries with high TB burden.¹ The government of India has since launched the National Strategic Plan (NSP) 2017–2025 to eliminate TB by 2025;² global elimination of TB being defined as less than one TB case per million population according the World Health Organisation (WHO).³

Studies have suggested that the private health sector in India serves as the first point-of-contact for 50–70% of patients with TB, and prescribes twice the amount of anti-TB drugs compared to the public health providers.⁴ However, a recent study demonstrated that the quality of TB care by the private care sector in India as being suboptimal – thus raising doubts whether the goal to eliminate TB in the country by 2025 can be attained.

The study reported only 35% of correct management according to national and international standards among a total of 2,602 patient-provider interactions – with a majority of providers having ordered a chest X-ray or having referred the patients for further care.⁴ Microbiological testing including drug susceptibility test was infrequent; the use of anti-TB drugs was minimal at 4.5% (118 interactions) with only 45 such instances considered correct treatment.⁴

The private practitioners were said to have treated the patients idiosyncratically without a consistent protocol.⁴ The authors of the study offered two explanations for such behaviour: providers facing difficulty diagnosing TB appropriately, and providers deviating from established standards for financial gain – resulting in poor diagnostic ability thus failing to offer correct management.⁴

In conclusion, addressing the quality of TB care delivered to patients is critical for India to achieve its goal to eliminate TB by 2025 – which may include the development of national guidelines to strengthen the private health sector engagement.⁵

References

1. World Health Organisation (WHO). Global tuberculosis report 2018. Available at: http://www.who.int/tb/publications/global_report/en/. Accessed November 2018.
2. Kanabus A. TB India – National Strategic Plan (NSP) 2017 – 2025, private sector care. Available at: https://www.tbfacts.org/tb-india-nsp/. Accessed November 2018.
3. World Health Organisation (WHO). The End TB strategy. Available at: https://www.who.int/tb/strategy/en/. Accessed November 2018.
4. Kwan A, et al. PLoS Med 2018;15:e1002653.
5. The Hindu Business Line. Can India eliminate TB by 2025? Available at: https://www.thehindubusinessline.com/opinion/can-india-eliminate-tb-by-2025/article23375133.ece. Accessed November 2018.