On 11 June this year, global health agencies that partnered with private doctors on the field to control tuberculosis (TB) rang a stark warning bell. The number of monthly GeneXpert tests GeneXpert tests GeneXpert Test A GeneXpert test looks for specific drug-resistant TB bacteria as well as whether it is resistant to first-line TB drug rifampicin. The test delivers results in an hour. —crucial for detecting drug-resistant TB drug-resistant TB The Ken The funereal pace of India’s anti-TB drug acquisition efforts Read more —conducted in May had fallen by a third when compared with January numbers.
“Eleven of the 15 cities in Bihar, Delhi, Rajasthan, and Haryana have zero stock of test cartridges,” said a senior executive from US-based Clinton Health Access Initiative (CHAI). This executive and others from multiple participating non-profit agencies that The Ken spoke to requested anonymity as they were not authorised to speak to the media.
The non-profit agencies were presenting to the Central Tuberculosis Division (CTD) embedded in the Ministry of Health and Family Welfare (MoHFW). The internal presentation, which The Ken accessed, was made to update the CTD on the progress made under the Project for Joint Effort for Elimination of TB (JEET).
JEET, through the creation of Patient Provider Support Agencies (PPSAs) (PPSAs) PPSA PPSA agencies are non-profits engaging with private doctors and patients to identify stakeholders in TB care. They work with stakeholders to decrease the incidence of TB. , was devised to solve three dilemmas in the private sector—TB cases that go unreported, treatments that are 35-40% more expensive, and doctors who fail to deliver TB care that adheres to standards.
Under the project, every time a doctor in the private sector diagnosed a TB patient, she would be given a cash incentive. The criteria for the incentive included, among others, getting the patient a GeneXpert test. But no tests meant no incentives. The programme was falling behind on signing up doctors.
In 2020, the Indian government identified 1.82 million TB cases, according to Nikshay, the official TB database maintained by CTD. But there are at least half a million more that slip through the cracks—patients who go to doctors in the private sector for diagnoses, but never make it on to the government’s list of TB patients in the country to be monitored and treated.