Health Spending

India can only contain its TB epidemic with cash and commitment

India’s national TB control programme has struggled to receive funding that is commensurate with the scale of the country’s epidemic.

Tuberculosis kills more people today than HIV and malaria combined.

In 2015, there were an estimated 10.4 million new TB cases worldwide and 1.8 million TB deaths, according to the World Health Organisation. And India is at the epicentre of this global epidemic, with half a million TB deaths annually. India also accounts for 16 per cent of the estimated 480,000 new cases of multi-drug-resistant TB.

Can India turn things around and control this epidemic?

The answer is a conditional yes. The Indian government has already taken several steps over the past few years to address it. This includes making TB a notifiable disease, developing the Standards for TB Care in India, introducing daily drug regimens and rolling out molecular and drug-susceptibility testing.

But there’s an opportunity to do more and better, and for India to assume a global leadership role.

Back ambition with money

Earlier this year, India’s Revised National TB Control Program published a draft of a new National Strategic Plan for TB Elimination 2017-2025. The plan, if fully funded and well implemented, could be a game changer in the fight against TB in India.

The plan aims to improve services and outcomes for the 1.5 million patients in the public system and to scale up access to new diagnostics and drugs. It also sets out a bold road map to reach private providers and support the millions of patients treated in the private sector.

Building on promising pilot results, the plan proposes to do so by providing incentives to providers – for following standard protocols for diagnosis and treatment as well as for notifying the government of cases. Patients referred to the government will in turn receive a cash transfer, to compensate them for direct and indirect costs of undergoing treatment and as an incentive to complete treatment.

The cost of implementing the new plan is estimated at $2.5 billion (approximately Rs 17,000 crore) over the first three years, a big increase over the current budget. Historically, despite being a highly cost-effective program and despite having a high absorptive capacity, RNTCP has struggled to receive funding that is commensurate with the scale of India’s epidemic.

This simply cannot continue. India must start backing its ambitions with rupees. Therefore, the real test of whether the bold plan by the health ministry can be implemented will be whether enough resources can be mobilised – to find, treat and offer quality care to all TB patients, regardless of where they live.

Health spending an urgent priority

TB is one of many diseases that affect Indians, and India is clearly under-performing on several key health indicators, as shown by a recent report on attainment on health-related Sustainable Development Goals in 188 countries. This is an analysis from the Global Burden of Disease Study 2016, which measured 37 health-related indicators from 1990 to 2016.

India did very poorly in this analysis, ranking 127 among 188 countries. In fact, every single other BRICS country (Brazil, Russia, China and South Africa) ranked ahead of India.

This analysis clearly shows that India’s economic progress is not reflected in the health of its people. India’s National Health Policy, approved this year, proposes to increase health expenditure by the government from the existing 1.15 per cent to 2.5 per cent of the GDP, by 2025.

Ensuring this increase should be an urgent priority for India, and an absolute requirement if India is to make progress towards universal health coverage.

A tradition of excellence

Are there areas of strength that India can leverage to fight TB?

India has made some impressive contributions in global health. India has been polio-free for more than five years and this success has propelled global efforts to eradicate polio. Indian biotech and drug manufacturers dominate the production of TB and HIV medications, accounting for more than 80 per cent of the global market.

The recent launch of a rotavirus vaccine produced in India has underscored the country’s leadership role in childhood immunisation. India also has huge strengths in IT and software that can be leveraged. And India has a long tradition of excellence in TB research, highlighted by the creation of an India TB Research Consortium.

So, with its strong research expertise in TB, and technological and pharmaceutical capacity, India has the potential to make great progress against this disease.

What is essential is a strong financial and political commitment from Prime Minister Narendra Modi to end the TB epidemic, and an overall greater investment in health. When health becomes a priority for India, TB will naturally decline, as will many other conditions that currently make India rank so poorly in health-related SDGs.

This article was first published on The Conversation.

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.