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The End TB strategy

Tuberculosis is a lethal disease affecting the productive population aged 15-45 years of age, robbing a country’s true resource-Human Resource. Perhaps, it would seem absurd that a disease of this old a history would still hold an iron grip on a country’s development by directly and indirectly affecting the health and wealth of a country. With continued efforts, we have saved 43 million lives globally, achieved 43% decline rate in the prevalence of Tuberculosis, reduced the death rate among HIV co-infected by one-third. The question still looms… Can these rates of decline actually bring down the Tuberculosis burden by decreasing the Incidence and Tuberculosis related death by 95%, and have no catastrophic burden on the families affected by 2025?

NEED FOR ACTIVE INVOLVEMENT OF STAKEHOLDERS IN END TUBERCULOSIS STRATEGY BY 2025

By definition, a stakeholder is a person or institutions that have a concern for that particular object of interest. With respect to Tuberculosis disease and END TB STRATEGY by 2025- A stakeholder could be defined as decision makers in health, managers of tuberculosis control programmes in public sector and for-profit organizations, Donors, Development agencies, NGO’s, supporting the cause in private sector. If India, a country home to approximately one fourth of the individuals suffering Tuberculosis affected globally has to make a tall claim as to achieve this target 10 years ahead (2025) of its proposed target of 2035 stakeholders, both in government and private sector need to forge strong policy decisions and timely complete implementation to stop the onslaught of the Tuberculosis juggernaut!

PUBLIC AND PRIVATE SECTOR STAKEHOLDER’S ROLE IN END TB STRATEGY

The Public and Private stakeholders have all that it takes to bring Tuberculosis down to its knees by solidarity and a strong convergence of will and determination and an aim to work toward a TB free India and world. The public sector has its own unique advantage of being universal in the country with an ability to make policy decisions that affect the people’s lives whereas the private sector has the machinery -Money, Manpower and infrastructure to bring about these changes once policy decision and implementation occurs.

ROLE OF STAKEHOLDERS IN PATIENT-CENTERED CARE

Public Stakeholders like policy decision-makers - influence policy on active detection of Tuberculosis patients and ensuring treatment completion and quality assured services in public healthcare facilities. A policy level implementation of mandatory notification of Tuberculosis patients is already occurring through NIKSHAY, it needs to percolate to every private and public-sector health provider to follow up presumptive tuberculosis cases with special care toward category-II patients, multi-drug resistant TB patients, HIV patients. Private sector stakeholders can supplement the drug testing activities and screening of the contacts of TB and high risk and vulnerable group for tuberculosis. Private agencies also play an important role in merging of HIV-TB collaborative activities, centres for advanced care for Tuberculosis who aid in the management of comorbidities of Tuberculosis.

The public stakeholders such as policymakers and managers should ensure high rates of vaccination with BCG, vaccinate those who have missed (e.g. Mission Indra Dhanush) thus decreasing a large pool of individuals presenting with paediatric Tuberculosis and complications. The private stakeholders have a more than a supplementary role to the public stakeholders. Non-governmental organizations like provision of directly observed therapy, defaulter retrieval, commodity assistance through a grant in aid. Private practitioners through public-private partnership can contribute by providing quality services to Tuberculosis patients and notification of tuberculosis patients.

ROLE OF STAKEHOLDERS IN POLICY MAKING AND SUPPORT SYSTEMS

This pillar has the foundation of the public stakeholders in the political commitment and making budgetary and non-budgetary provision of resources for prevention and care of TB among affected individuals, social protection, and poverty alleviation. Making Universal health coverage a reality largely is dependent on policy decision makers on health through the national strategic plans, governmental schemes, public sector health insurance thus decreasing the catastrophic burden of TB affected individuals and their family.

The private sector stakeholders play the role of the superstructure of this pillar by supporting the prevention and care of TB through advocacy, communication and social mobilization, infrastructure for more gender sensitive and socially inclusive engagement of communities, non- governmental organizations forging the alliance between public and private stakeholders through its influence on other dimensions of healthy- emotional, mental, vocational and socio-economic dimensions.

ROLE OF STAKEHOLDERS IN RESEARCH AND INNOVATION

Public sector stakeholders through national programmes have incentivized research in tuberculosis-related thrust areas or research drought areas for undergraduate, postgraduate and other scholars in epidemiology related branches through grants and funded projects. Here they utilize the data for further policy change in the field of discovery, development and rapid uptake of interventions and strategies based on the research. Use of newer tools in epidemiology- health impact assessment, big data and deep neural networks for analyses of the vast amount data on tuberculosis generated in India and globally a weapon for a timelier warning system and trend assessment of tuberculosis especially when such research undertaken is translated to field level realities. This is possible again through funding and grants for research of this magnitude.

Private sector stakeholders too, like public sector provide grants and aid young scholars to take up such areas of research in tuberculosis thus promoting innovation and optimize implementation by supporting the public sector in health impact assessment and promoting innovations.

FUTURE DELIBERATIONS NEEDED AMONG STAKEHOLDERS’ PATIENTS AND HEALTH CARE INSTITUTIONS

 The wiping out of Tuberculosis disease by 2025 needs a combined effort of Healthcare providers and institution and patients through the interplay of stakeholders. Public Stakeholders have an important role in initiating the drug policy and detection and treatment standardization for a safe and shorter and complete quality assured treatment and patient support in public and private healthcare sectors. This can be made possible by adopting methods to improve the yield of cases through a case and record linkage of individuals based on Aadhar like schemes, treatment and completion incentivization for both patients and healthcare providers in private and public sector for timely prevention and care of TB affected families.

 The private sector stakeholders that has the necessary machinery to make this a reality can contribute in the upcoming active case finding through Information, communication and education of patients, provision of mental and vocational rehabilitation through engagement of patients in a gender sensitive and socially inclusive environment especially the NGOs working with high risk groups like HIV and slum dwellers and migrants. The private stakeholders like the Non- governmental organizations play an important role in advocacy to the public stakeholders. The development of innovations especially related to early detection or diagnosis of tuberculosis is how the tuberculosis disease onslaught could come to a grinding halt. Needless to say, -solidarity, a strong will and determination to work with public stakeholders is needed to achieve end TB strategy in collaboration with patients and healthcare providers.

In conclusion, the private and public stakeholders and how they impact patient centred care, policy-making and provide support systems along with the adaptation of newer tools and technology to curb tuberculosis will be a strong determinant of whether India can Blaze the Trail of End TB strategy by 2025.

Dr Ankeeta Menon, K.S.Hegde Medical Academy

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