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