Covid-19, now a familiar pandemic, has shaken humanity and disrupted life globally and across India. People are fatigued, economies have been affected, and everyday life has been hobbled. However, the effect of the pandemic on other persistent health challenges, such as tuberculosis, or TB, is probably the most significant and devastating.
During the first and second waves of the pandemic, TB services were disrupted as the health system struggled to cope with the onslaught of Covid-19. This exposed the systemic weaknesses as well as the the lack of resilience within vertical programmes such as TB.
As the third wave of Covid-19 in India recedes, TB has been relegated to the back-burner if not forgotten. It is urgent now more than ever to think beyond platitudes and act.
TB, though curable, remains India’s severest heath crisis after Covid-19. It affects 2.8 million Indians and kills over 1,200 every day. Developing an effective strategy to address tuberculosis along with Covid-19 requires urgent action. For this, we need to work across party lines, not just at the national but also state levels, to address these twin epidemics together.
During the Covid-19 pandemic, tuberculosis services were affected leading to delays in diagnosis, treatment, access and increased suffering for those affected. TB was often missed or underdiagnosed as overburdened hospitals and testing centres focussed on Covid-19.
In the public sector, overburdened staff struggled to deal with the increasing demands of TB patients. In the private sector, the symptoms of TB were missed in the hurry to diagnose Covid-19. Those diagnosed were often unable to access treatment and felt helpless and confused, causing them to give up.
Where treatment was available, the lack of patient support, absence of information, and in many cases, the difficulty in managing side-effects was devastating. While the long-term implications of the pandemic are not entirely clear, a crippling rise in TB cases is bound to be one of the ripple effects.
As concerned citizens, it is time to come together and consider how to move forward from here. For starters, TB requires renewed focus. For that, political will that leads to resources and action is imperative. Investing in TB and developing new strategies is required because doing the same thing will lead to the same results
Therefore, current plans for TB need to be revisited in light of the pandemic. Existing delivery approaches should be adapted in the context of a pandemic. No patient should give up on treatment due to affordability concerns or side. Every TB patient should be traced and provided with free, high-quality treatment at their doorstep.
The need to bring in remote support and communication is urgent. Patients should be provided information and education in their local language to better manage treatment-related challenges. Further, patient queries should be addressed through local networks, public communication and other kinds of support.
Expecting poorer patients to continue treatment without providing economic support, especially in this economic climate, is counterproductive. The Nikshay Poshan Yojna, though a well-intentioned scheme, faces gaps in implementation and the monthly amount – a mere Rs 500 – remains inadequate. As Covid-19 devastates the informal economy, it is urgent to ensure TB patients receive economic support. There is a felt need to act immediately on this issue.
Stigma and the gendered aspect of TB remain ignored too. While TB affects more men than women, who, along with other gender minorities, are more likely to receive poor treatment and face harassment. The government needs to revisit its approach as outlined in its Gender Responsive Framework and make TB care truly inclusive.
Stigma, unless actively addressed, can lead to loss of family, employment, and even discrimination and abuse. Those affected often hide their affliction and abandon the treatment midway.
Another important aspect is engaging the private sector as partners as it addresses more than 50% of all TB cases in India. It must be ensured that only qualified private providers take on the treatment and management of TB cases. The government efforts on private sector engagement made previously have weakened and need to be strengthened.
For decades, TB has destroyed lives and pushed millions into poverty and debt in India. Hence, political will and financial commitment for a renewed focus on TB is critical. The Covid-19 crisis is a wake-up call but also an opportunity to improve access to TB services. Let us not squander it.
Priya Dutt is a former MP and a TB survivor.
World Tuberculosis Day was observed on March 24.
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