RELIABILITY OF GOVT. HEALTH DATA

Isn’t the entire controversy invalid since cure rates of this program are superb 85%?
Summary:
To silence criticism, the government is projecting superior results obtained in a group of easy-to-cure patients (Cat I) as cure rates of the program per se, as if those were obtainable in all segments of patients, a dishonest practice. Moreover, hasn’t govt.’s health data often proved false and misleading in the past?
Details:
Don’t fantastic cure rates of 85% automatically make the entire criticism and controversy null and void?
They ought to.
But there is more to it than meets the eye.
The million-dollar question is ‘do 85 out of 100 patients registered with the program really get cured?’ as vociferously projected.
No.
The projection that ‘the cure rate of the program is 85%’ is in a way a veiled bluff. The cure-figure of 85% in reality pertains (not to all patients who enter the program but) selectively to just one segment of patients – consisting of fresh, new sputum smear positive patients who are rather easy-to-cure. It is a classic example of the game of statistics being played at its very best. Such clever choice of a convenient indicator to reflect cure rates of the entire program is symbolic of dishonest attitude and a systematic misinformation campaign conceived and unleashed from day 1 from the ramparts of the highest, holy quarters!
Prayer No. 7
Government of India and all state and union territory governments must be ordered to desist forthwith from unfairly projecting this figure as the cure rate of the entire program per se; it must be specified clearly what this figure is – cure rate of ‘new sputum smear positive cases’ only.
Reliability of govt. health data:
A disturbing but recurring pattern of juggling with heath figures in erstwhile flop programs. Is the clever game of statistics clouding the truth in RNTCP as well?
Through statistical acrobatics, often a rosy picture has been initially painted – till the honeymoon lasts, till funds are still flowing in or till the public focus shifts away to some other issue. Such dubious practices in the past have depleted the entire moral or ethical capital that the government might have had.
Should we yet again gullibly believe the magical cure rate figures being 85% without diligent scrutiny?
Watch out, several warning signals are already emanating from the nascent program:
• A Mumbai study* (20) found cure rate (even in new sputum smear positive cases) to be lower – 70%.
• Of 225 ex-patients revisited, 23 recorded as ‘cured’ were not found alive in a Sonipat study* (21).
• Also, possibly to effortlessly boost cure rates, 18.3% patients were found in the same Sonipat study to have been wrongly put in category I* (22).
• Cure rate in category II (housing difficult-to-cure, chronic cases) was 69% in 2001 and which curiously stands excluded from all calculations and projections.
• Success has tripled:
Further, vociferous comparison with the erstwhile program NTP (which was a disgraceful national failure) claiming ‘success has tripled’ is blatantly unfair for several reasons; not the least because a generational switch in chemotherapy – sadistically deferred by the government for several years – has now taken place.
• Data oriented and not human oriented approach:
The approach seems to be purely data – and not human – oriented; living patients seem to be dealt unemotionally – as if they were mere dots on a spreadsheet in this data game.
• Pressure tactics over temporary workers:
Setting up of stiff targets fosters fudging of facts. For ad-hoc employees (LT, STS, STLS etc.), perpetually insecure and desperate to retain their jobs, survival clearly hinges on coming up with the right figures and reports – by hook or by crook – saying just what the bosses want to hear.
• Unbelievable figures:
District Vaishali (situated in a relatively lawless, non-performing state of Bihar) consistently tops national performance with cure rates of the district touching 94%* (23) – a claim that appears simply too good to be true.
• Faulty data collection technique:
The technique itself needs to be radically decentralized and modified. Curiously, a single doctor (the district TB officer) unilaterally collects, compiles and files voluminous 8-page quarterly and 3-page monthly reports from an entire district. In the process, his entire staff – MO, STS, STLS, HV and LT – remains bogged down with the laborious albeit theoretical exercise covering over 100 parameters, including umpteen percentages, annual rates and ratios, with no relevance to the field staff. It appears that they, at the expense of actual service to patients, are grilled in compiling details required by senior scientists to enable them to effortlessly publish their research papers.
Prayer No 8.
It is prayed that the data compilation may be modernized, harnessing the current revolution in information technology. Under the program, a computer with Internet connection has already been provided in each district along with a Data Entry Operator, who will forthwith place, maintain and update ONLINE – all the three main documents – TB register, Lab register and the stock register every day. From these inputs RNTCP consultants ought to prepare reports on their sleek laptops and secretarial help lavishly maintained at the expense of the WHO.