Latest news with #NationalTuberculosisEliminationProgramme
Scroll.in
13-06-2025
- Health
- Scroll.in
As counsellors, they help fellow TB patients recover. Now a fund squeeze has left them high and dry
In January 2020, an official at a primary health centre in Jharkhand told Khageshwar Kumar about a drug-resistant tuberculosis patient who had stopped taking medicines for the last two months. Kumar stepped in. For 18 months, he visited the patient in Parasnath block in Giridih district three times a week, counselling him in sessions that lasted three hours or more. 'He had become suicidal. Even his family had given up on his treatment,' Kumar said. 'For hours I would talk to him. I was able to help him because I was a TB patient myself. I can relate to how patients feel.' Kumar is a TB Champion or TB Vijeta, a term coined for patients cured of the bacterial infection, who are then drafted to the National Tuberculosis Elimination Programme. Their role – to counsel other patients and raise community awareness. In this case, Kumar's efforts paid off. He convinced the patient to resume his medicines and helped him through their painful side-effects. The patient went on to finish his treatment in 2022 and is now employed with a private firm. Khageshwar Kumar was diagnosed with tuberculosis in 2007 and cured the same year. The 29-year-old began working as a TB Champion in Giridih in 2019 for an honorarium of Rs 6,000 per month. 'The amount was small, but I had no other job and I was passionate about TB,' he said. Since 2023, however, that money has stopped. Several TB Champions have dropped out of the programme in Jharkhand, though some like Kumar do limited volunteer service in spare time. 'For how long can we work for free?' Kumar asked. A support group The TB Champion programme was initiated in India in 2016 as a major component under the National Tuberculosis Elimination Programme, which aimed to eradicate tuberculosis by 2025. The deadline, missed by India, has now been pushed to 2030. But across India, the programme is under stress, with multiple states complaining of delay in financial reimbursement or a complete freeze in funds. Each state allocates a different amount as fee for the former tuberculosis patients. In some states, NGOs partner with the government and pay the amount. In May, Nishant Kumar, joint director of the central tuberculosis division was asked why the programme was struggling at a conference. 'TB Champions (programme) has not stopped,' Kumar said. 'It is transitioning.' But several counsellors Scroll spoke to said irregular payments are a problem. In Haryana, Sagar Verma, who is the TB Champions Network President, said he received Rs 8,000 per month until 2024 through an NGO called World Vision that had partnered with the government. 'It stopped due to funds shortage,' he said. Verma now works at a district hospital in Haryana. 'There are over 100 counsellors like me who are jobless in the state. We have approached state authorities multiple times to release funds for this programme,' Verma said. The last time, the counsellors engaged with tuberculosis patients in Haryana was March 2024. In Odisha, counsellor Kailash Mishra has not received April's honorarium till date. 'The state government said that March funds have not reached them from the Centre.' Mishra visits four patients every day and does regular district level reporting of cases apart from conducting community meetings to raise awareness. For this, he receives Rs 3,500 a month from the Odisha government. 'The payment is frequently delayed,' he said. 'Many of us travel 200 km to district headquarters for meetings. Sometimes we also collect sputum to test for TB bacteria,' Mishra said. Although the National Tuberculosis Elimination Programme permits states to reimburse counsellors for such services, Mishra said no reimbursement is given to them. Eldred Tellis, founder of Sankalp Rehabilitation Trust, said the issue has become acute in the last few months. 'Whenever we approach state officials, they cite fund shortage,' he said. 'The central ministry refuses to acknowledge this problem. This has not only cut the source of livelihood for TB Champions, it has also affected patient care.' Other health activists agreed that the absence of the counsellors would hurt patients. 'TB Champions fill a crucial gap in the programme by providing mental health support to patients,' said health activist Ganesh Acharya. 'In their absence a major component will be lost.' 'A vital part' In 2016, Reach, a non-profit that partnered with the government on tuberculosis control, trained its first cohort of 25 TB Champions and went on to train 3,000 such counsellors. Ramya Ananthkrishnan, director at Reach, said the aim was to provide a support group for TB patients. 'They play a vital part. Some look at advocacy, some get deeply involved in the programme to handle treatment and diagnosis,' she said. Across India, the National Tuberculosis Elimination Programme has trained over 30,000 champions till 2023. In Mumbai, a hotbed of drug-resistant tuberculosis, the Brihanmumbai Municipal Corporation relied heavily on the TB Champions to carry out door-to-door visits and engage with the community. Till last year, Maharashtra paid the highest compensation to the counsellors, at Rs 10,000 a month. Moreover, the counsellors were employed by the civic body on a contractual basis. But in June 2024, the civic body discontinued the programme. About 25 people employed to counsel patients were rendered jobless. 'Few were retained and assured of payment. But since the last eight months, they have not been paid,' said activist Meera Yadav. Yadav said that the funds meant for the programme were discontinued by the state's TB division due to overall budget cuts. A state government official requesting anonymity said funds under the National Health Mission have been "delayed consistently'. 'We use NHM funds for various diseases, including tuberculosis,' the official said. 'This year, the funds were supposed to be disbursed by March. We have not received them till now.' The delay and underutilisation of funds is apparent in the 2023-24 budget and expenditures made by the National Tuberculosis Elimination Programme. Out of a budget of Rs 1,888 crore, the programme had spent only Rs 840 crore till March 15, 2024. For 2022-23, the programme spent Rs 910 crore out of the approved budget of Rs 1,666 crore. Some officials employed with NGOs, who work with the government on tuberculosis, told Scroll that the abrupt end of funds from the United States Agency for International Development this January has also forced them to curtail spending on TB Champions. Shazad Ahmed, who is a TB Champion in Balrampur, Uttar Pradesh, stopped receiving a monthly honorarium of Rs 8,000 from 2024. He was being paid by Reach. He still continues to work though in the hope the government will resume payments. 'I am working to help other patients. I will continue to work for free as long as possible.'
The Hindu
02-06-2025
- Health
- The Hindu
Small change in MBBS education curriculum can make substantial impact on early detection of TB: study
Tuberculosis (TB) remains one of India's most significant public health challenges, with the country accounting for nearly a quarter of the global TB burden. Despite a robust national programme and the availability of free diagnostic and treatment services under the National Tuberculosis Elimination Programme (NTEP), early detection of the disease continues to fall short. Many individuals with symptoms of TB go undiagnosed for weeks or even months, contributing to continued transmission within communities as well suffering avoidable health complications. The delays in diagnosis are often attributed not just to gaps in health infrastructure but also to a lack of early suspicion at the primary point of care. Patients commonly approach local healthcare providers with symptoms like persistent cough, weight loss, fever, or night sweats. However, these symptoms are frequently misattributed to other conditions or treated symptomatically, without considering TB as a possible cause. This widespread failure to 'suspect TB' -- a critical first step -- has been repeatedly identified as a major reason for missed cases. It is in this context that a community-based screening model was introduced at Bharati Vidyapeeth Medical College in Pune. The goal was to find a sustainable, scalable way to improve TB case detection while simultaneously integrating public health practice into the medical curriculum. The innovation came through the Family Adoption Programme (FAP), a nationwide initiative mandated by the National Medical Commission, which assigns medical students to specific rural or urban communities for continuous engagement throughout their training. The study learnings from integrating TB screening activity into FAP for MBBS students was published in Frontiers in Public Health. The first point of contact and active case finding Swathi Krishna, TB researcher and public health physician based in Pune and key faculty member behind the programme's implementation, explains the rationale, 'In our healthcare system, the first point of contact is often a missed opportunity. Students are the future of that system, so we need to train them not just in hospital-based care but in recognising the realities at the ground level.' Under this initiative, MBBS students visiting households began asking just four simple symptom-based questions related to TB. If any symptom was reported, the case was flagged and referred to the local ASHA (Accredited Social Health Activist) for follow-up and testing. This low-cost, high-reach strategy is referred to as 'active case finding', a method endorsed by the World Health Organization (WHO) and the NTEP, but rarely operationalised at scale in routine community interactions. The results were encouraging: not only did the students identify presumptive TB cases, but they also became more confident in recognising its early signs and engaging with communities on sensitive health issues. The involvement of ASHA workers was crucial. According to Dr. Swathi, 'ASHA workers are already doing so much. When students collect these symptom reports during household visits, it lightens the ASHA worker's load and makes their follow-up more targeted.' In effect, the programme bridged the gap between community-based medical education and primary care outreach, enhancing both the learning experience of students and the reach of public health services. Breaking stigma barriers through continuos awareness Sanjivani Patil, associate professor in the Department of Community Medicine, adds that the model is particularly powerful because of its continuity. 'Unlike a one-off camp, the FAP ensures that students are visiting the same families regularly over three years. This builds rapport. Initially, people are hesitant to talk about TB symptoms because of stigma or fear. But with time, they open up. They trust the students.' Stigma remains a formidable barrier. In many communities, TB is still viewed with fear and shame, leading patients to conceal symptoms or delay care. Awareness about the Nikshay Poshan Yojana—a scheme under the NTEP that provides free treatment, nutritional support, and diagnostics—is also limited. But the presence of students, guided by faculty mentors and supported by local health workers, gradually breaks down these barriers. Community engagement activities such as street plays, awareness rallies, and health talks further reinforce positive messaging and reduce misinformation. From an educational standpoint, the intervention fits seamlessly into the competency-based medical education (CBME) framework. Students are trained to communicate effectively, collect and analyse health data, and understand the social determinants of disease. Their work is assessed through logbooks and field reports, ensuring accountability. As Dr. Patil observes, 'This experience gives students a reality check. In hospitals, they see rare diseases. But in the field, it's about cough, fever, diarrhoea, and skin issues. These are the cases they will encounter as primary care physicians. They learn to think beyond the textbook.' Possibilities of expansion, challenges and further research The programme's design also allows for replication. Every medical college implementing FAP can adapt this TB symptom screening model. Each batch of MBBS students is assigned around 800 households, translating into a wide population base being covered. Urban settings are not excluded -- Urban Health Training Centres (UHTCs) affiliated with medical colleges can deploy the same approach in underserved city neighborhoods, slum areas, or industrial zones. Saibal Adhya, another senior faculty member at the college and co-author of the study, highlights the policy implications. While India's TB programme is well-resourced, he points out that treatment and testing still need to be more accessible at the grassroots level. 'Even though the services are free, the unavailability of drugs or closed diagnostic labs leads people to spend from their own pockets. That's where trust in the system erodes,' he says. He also recommends that regular faculty development sessions and workshops on NTEP guidelines be institutionalised across all medical colleges. 'You cannot expect students to be champions unless their teachers are aligned with national health priorities,' he says. Authors also point out the importance of such TB screening initiatives, as a modest change in routine educational practice can make a substantial impact on both medical training and public health outcomes. Dr Swati says, 'It reinforces the idea that meaningful change does not always require massive infrastructure or funding. Sometimes, it just takes the right questions asked at the right time by the right people.'
Time of India
14-05-2025
- Health
- Time of India
PM Modi chairs meeting with Nadda to review TB elimination campaign progress
New Delhi: Prime Minister Narendra Modi convened a meeting on Tuesday to assess the progress of the tuberculosis elimination campaign. Union Health Minister JP Nadda and other leaders attended. The Government of India has implemented various focused strategies under its National Tuberculosis Elimination Programme (NTEP) to tackle this significant burden. These key initiatives under NTEP aim to strengthen diagnosis, treatment, and prevention efforts, accelerating progress toward a TB-free India. In 2020, the Government of India renamed the Revised National Tuberculosis Control Program (RNTCP) the National TB Elimination Program (NTEP). This reflects India's goal to eliminate tuberculosis (TB) by 2025, five years before the global target of 2030, according to the release. According to WHO's Global TB Report, India has made significant progress in fighting tuberculosis. Under the National Tuberculosis Elimination Programme (NTEP), the incidence rate of TB cases has dropped by nearly 17.7 per cent, from 237 cases per 1 lakh people in 2015 to 195 in 2023. TB-related deaths have also reduced, falling from 28 to 22 per 1 lakh people during the same period, as stated in the release earlier. The NTEP follows the National Strategic Plan (2017-2025), focusing on four key actions: Detect - Treat - Prevent - Build (DTPB) to control and eliminate TB in India. To eliminate TB by 2025, the NTEP programme achieved the highest-ever number of case notifications , reporting 25.5 lakh TB cases in 2023 and 26.07 lakh cases in 2024. It is the first-ever Indigenous TB burden mathematical model that estimates state-wise TB. The programme also provided incentives for ASHAS, TB Champions & Caregivers, thus strengthening patient support systems. The programme focused on the high-risk group and found 3 lakh additional cases via house-to-house screening. 560 colleges supported TB detection & research, also regular surveys, drug sales tracking, and under-reporting assessments conducted, also collaboration with ministries, industries, NGOS & technical bodies also done, as stated in a press release.
TimesLIVE
14-05-2025
- Health
- TimesLIVE
US aid freeze leaves TB survivors in India ‘high and dry'
By Sudeshwar Singh, a tuberculosis survivor and health activist, used to co-ordinate and mentor about 800 advocates in India's eastern state of Bihar, part of a grassroots network that plays a pivotal part in global efforts to end the epidemic by 2030. However, since the US suspended foreign assistance earlier this year, Singh had to drop his work ensuring patients get treatment and instead search for a new job as the sole breadwinner in his family of four. 'Most of us ourselves are affected by TB and committed to the TB community, but when our own income is affected, how do we support others?' he said. Singh, 48, is the founder of TB Mukt Vahini (TMV), which roughly translates as the Army for a TB-Free Community, one of two dozen community-led health organisations in India whose funding has dried up since US President Donald Trump dismantled the US Agency for International Development, or USAID, under his 'America first' foreign policy. Singh and other survivors of tuberculosis who were trained as 'TB champions' are on the front line of India's response to the disease, working in their communities to raise awareness, reduce stigma and support patients in a country with the highest number of infections in the world. USAID has spent more than $140m (R2.5bn) since 1998 to fight TB in India, where an estimated 2.8-million people have the disease, more than a quarter of cases worldwide. Without groups like TMV, public health experts in India are warning of a spike in infections and deaths from tuberculosis, an infectious disease caused by a bacteria that can kill half of patients who do not receive treatment. 'It is with great difficulty that we found TB survivors who were trained to be TB champions. How can they work without support?' asked Blessina Kumar, who is based in New Delhi and is CEO of the Global Coalition of TB Advocates, an organisation with 540 members in 76 countries. 'The TB community is left high and dry due to the USAID funding problems, and their work (is) left incomplete.' Bihar, where TMV worked with TB patients, is one of the country's most impoverished and populous states, with an annual per capita income of less than $500 (R9,115). 'With the recent freeze we are unable to sustain our operations,' said Singh. The TB champions working with Singh co-ordinate with government health centres and guide patients through treatment to make sure they receive medication. The survivor-led networks also provide patients with emotional support amid the challenges of treatment while facing potential discrimination in the community. India's National Tuberculosis Elimination Programme (NTEP), which has an annual budget of $492m (R8.9bn), is almost entirely funded by the government to procure drugs and provide diagnostics. USAID awarded grants and contracts to government agencies, non-governmental organisations and the private sector, whose work on controlling TB has helped shape the Indian government's policies on fighting the disease. However, the agency's annual investment of $100,000 (R1.8m) in community-based organisations ensured that vulnerable populations, including the urban poor, miners and migrants, were reached. Across the world, foreign funding accounts for about a fifth of the money spent fighting TB, and the US previously contributed more than 55% of the funds, according to the Geneva-based Stop TB Partnership administered by the UN. Subrat Mohanty, a board member with Stop TB Partnership, said shelters for destitute patients in India and other small organisations were specially hard hit by the collapse in US aid. 'They are not getting any money, neither are any activities happening, including healthcare screening, taking TB patients to the diagnostic facilities or follow-up for further treatment,' he said. Mohanty fears India's goal of ending TB this year is in jeopardy. 'At the end of the day, it is the community that has to use the diagnostic tools and has to come for screening. If they are not going to be sensitised or empowered, how will the (national) programme see results?' A Stop TB Partnership study showed USAID's funding cuts could lead to as much as a 36% rise in cases and a 68% jump in deaths to 2.24-million by 2030 in 26 high burden countries. 'The withdrawal of US support threatens essential TB services, including diagnostics, treatment, TB-HIV co-infection interventions and research initiatives critical to achieving TB eradication,' the study said. Mohanty said India must devote more of its own money to curbing tuberculosis and seek assistance from non-traditional TB donors such as Denmark, Sweden, South Korea and Japan. India is the world's third-biggest producer of pharmaceuticals, putting it in a better position than other countries, specially in Africa, that have relied on USAID to purchase life-saving medication to treat tuberculosis. However, experts said the Indian government has not publicly acknowledged the impact of the loss in USAID assistance. Urvashi Singh, deputy director-general of the NTEP, did not respond to questions sent by text message and e-mail. Kumar said: 'India has enough resources to meet the gap through government and private funding, but it needs to act now.'
India Gazette
13-05-2025
- Health
- India Gazette
PM Modi chairs meeting with Nadda to review TB elimination campaign progress
New Delhi [India], May 13 (ANI): Prime Minister Narendra Modi convened a meeting on Tuesday to assess the progress of the tuberculosis elimination campaign. Union Health Minister JP Nadda and other leaders attended. The Government of India has implemented various focused strategies under its National Tuberculosis Elimination Programme (NTEP) to tackle this significant burden. These key initiatives under NTEP aim to strengthen diagnosis, treatment, and prevention efforts, accelerating progress toward a TB-free India. In 2020, the Government of India renamed the Revised National Tuberculosis Control Program (RNTCP) the National TB Elimination Program (NTEP). This reflects India's goal to eliminate tuberculosis (TB) by 2025, five years before the global target of 2030, according to the release. According to WHO's Global TB Report, India has made significant progress in fighting tuberculosis. Under the National Tuberculosis Elimination Programme (NTEP), the incidence rate of TB cases has dropped by nearly 17.7%, from 237 cases per 1 lakh people in 2015 to 195 in 2023. TB-related deaths have also reduced, falling from 28 to 22 per 1 lakh people during the same period, as stated in the release earlier. The NTEP follows the National Strategic Plan (2017-2025), focusing on four key actions: Detect - Treat - Prevent - Build (DTPB) to control and eliminate TB in India. To eliminate TB by 2025, the NTEP programme achieved the highest-ever number of case notifications, reporting 25.5 lakh TB cases in 2023 and 26.07 lakh cases in 2024. It is the first-ever Indigenous TB burden mathematical model that estimates state-wise TB. The programme also provided incentives for ASHAS, TB Champions & Caregivers, thus strengthening patient support systems. The programme focused on the high-risk group and found 3 lakh additional cases via house-to-house screening. 560 colleges supported TB detection & research, also regular surveys, drug sales tracking, and under-reporting assessments conducted, also collaboration with ministries, industries, NGOS & technical bodies also done, as stated in a press release. (ANI)
