WHAT NEEDS TO BE DONE IN INDIA TO IMPROVE TB CARE AS WELL AS PUBLIC HEALTH?
1. Half of the TB patients go to the government clinics and thus enter Revised National TB program (DOTS), which needs further strengthening. We must urgently revisit all controversies and resolve them.
2. This TB control program is being run at the village level by government’s public health-care system, which itself is in shambles and craves radical reform.
3. Half the patients go to private sector – still un-involved in TB control.
4. Numerous cases suffer & die at the hands of quacks, which must stop.
5. Besides, there are several other non-medical angles – like creating sufficient public awareness, improving drug quality etc., which have indirect bearing over TB control and which need urgent attention.
Suggestions to refurbish India’s TB control and general health care systems etc. have been comprehensively listed as Prayers in the Public Interest Litigation (CWP (C) No. 185 of 2007) filed by TB Free India and Dr. Raman Kakar in Dehi High Court. A mechanism must be put in place to critically examine / implement each prayer.
Summary of minimal critical prayers:
The Hon’able Court may kindly direct the government:
(1) Govt. must divulge as to how many Indians died of TB during the first national TB program (1962-92).
(2) To ensure that each TB patient, even sputum positive, must undergo a chest X-ray at diagnosis, and then at 2, 4 & 6 (or 8) months of treatment.
(3) To end mismanagement of Clinical specialist who must be posted only in his own field. To correct all such anomalies in 3 months through 20 steps enumerated in Prayer 13.
(4) To appoint only Chest or Medicine expert as District TB Officer, who will supervise and help doctors in the field as suggested.
(5) We must convert thrice-weekly to five doses a week regime, without increasing patient’s visits.
(6) In cat. II, Streptomycin must be given for full 3 months instead of 2.
(7) Superior cure rates obtained in new sputum smear positive cases must not be falsely projected as if obtained in all categories.
(8) To place & update ONLINE all 3 Registers (TB, Lab & Stock), patient’s names, addresses, status and all evaluation reports.
(9) To publish promised booklet for empowering patients in 3 months and translate in common Indian languages in another 3 months.
(10) Govt. must proactively push R&D for a vaccine.
(11) Any other relief.
(12) To install X-Ray Plant in each 24 X 7 PHC (Primary Health Center) in 2 phases.
(13) To Incorporate in to NRHM our Vision 2012: Transform each of our 600 district hospitals in to a mini-AIIMS so as to reach world-class health care near every citizen.
(B) India is short of 600,000 doctors. To define exact timeline for implementation of Indian Public Health Standards (IPHS) for hospitals etc.
(C) To complete in 3 months, ‘Minimal Quorum of 6 experts’ in each district hospital of India: One each of the following specialists: Medicine, Pediatrics, Surgery, Gynecology, Orthopedics and Anesthesia. Absence of even one of these cripples the hospital.
(H) To create a separate cadre for Clinical Specialists and to diligently post each one in his own field and at an appropriate center.
(K) To have a separate cadre of retired, private and willing-serving surgeons for Family Planning operations and to pay them (say Rs. 50) per Vasectomy / Tubectomy done.
(L) To have separate cadres for Program managers and for Administrative posts.
(M) To identify, train a cadre of govt. doctors for ultrasound, a little-used life saving tool.
(N) To direct MCI to start a Degree / Diploma in Emergency Medicine as in USA etc.
(O) To identify & train doctors for ‘Emergency Medicine’ and to post them only in casualty.
(P) To have a separate cadre for Jurist Doctors to handle all post mortem and other legal work.
(Q) To simplify court evidence duties of govt. doctors by taking 3 suggested steps.
(R) To abolish VIP duty for govt. doctors, which is mockery of the poor needy public.
(T) To have similar cadres for nurses too for casualty, delivery, OT, administrative work etc.
(14) To ensure that Central govt. spends 3% of GDP on ‘Health’ (with 1% annual rise till it reaches 10%); that States and UT’s spend 5% of Total Budget on Health (with 1% annual rise till it reaches 10%); that non-utilization of the Health Budget is declared a crime.
(15) To provide health insurance cover to each poor citizen. To make it compulsory for every EPF subscriber to enroll simultaneously with ESIC scheme.
(16) To strive for the vision of having one Medical College in every district of India. Each MC will adopt the nearest govt. hospital / CHC.
a) To end falsehood perpetrated (as stated) in some new medical colleges.
b) To ensure that idle medical colleges started in jungles adopt a nearby govt. hospital.
c) To open a new Medical College only in a deprived district.
(17) To create ‘Regulatory Authority for clinical labs’ & ‘Indian Council of Lab Technicians’.
To upgrade, modernize lab in each PHC.
(18) Inculcate partnership between private and govt. hospitals, which can be harnessed for training of personnel, national programs, creating mass awareness etc.
(19) A nation wide mechanism for regular and systematic exchange of health notes amongst all states and union territories, which work in isolation.
(20) Amalgamation and integration of all health related funds.
(21) Infuse specialization in IAS and other elite services first.
(22) Abolish confidentiality, make Annual Reports (ACR) transparent.
(23) Glaring anomalies in deployment of experts in every govt. department must be identified and set right.
(24) Mechanism to regularly and verifiably upgrade awareness of govt. doctors in every state and UT.
(25) To permit only reputed large companies to produce anti-TB drugs.
To set up a drug testing lab in each district.
(26) Install a district TB watchdog committee to oversee and verify cure rates by visiting patients.
(27) To review with orthopedic surgeons treatment of Bone TB etc.
Mandatory blood sugar tests and HIV screening for every TB case detected.
(28) (A) To “Club TB Awareness with HIV awareness.”
Attach TB compartments with train for AIDS awareness.
(B) To direct NCERT (National Council for Education, Research & Training) to increase coverage of TB etc. in school curriculum.
(C) To investigate profligacy and failures of the mass communication firm, hired.
To overhaul IEC (Information, Education, Communication) department in TB Division and CHEB (Central Health Education Bureau).
(D) To create a special Agency for Health Awareness that will rope in Prasar Bharti, film industry, electronic & print media to create countless tools of awareness (e.g. Films, Serials, Quiz, Songs, Poems, Ghazals, Dance numbers, Presentations, Stories and Cartoons etc. in various languages) on TB, Malaria, Dengue, Typhoid, Jaundice, Leprosy, Anemia, Nutritional Deficiencies, Worm Infestation, Diarrhoea, Dysentry, Kalazar, HIV and Chickengunia etc.
(E) Make special modules for politicians, bureaucrats, religious heads, public, patients, relatives, doctors, nurses, workers, high-risk groups, and media.
Then to ensure bombardment of these messages across the nation.
(J) Rather than just a day (World TB day, the 24th March), dedicate a full week to TB awareness.
To end stunned silence of Prasar Bhatati, AIR and Door Darshan etc.
To direct DPRO (District Public Relation Officer) to plant TB material in press and cable network. and Deputy Commissioner to oversee awareness campaigns in school, college.
(O) 5-minutes compulsory newsreel on health in interval of each film show across India.
To coax private TV, FM channels and religious organization for creating awareness.
A private doctor must be provided copies of the booklet on TB (9) within 6 months.
(32) To reopen TB ward of the District Hospital Faridabad and fix accountability for closure.
(B) To make it mandatory to report each TB death with a chosen NGO.
(35) Free ration to patient as incentive from local ration depot of Public Distribution System.
To create awareness as elaborately explained.
(42) To first define who is “seriously ill” and then lay down a ‘Specific Protocol of Referral’ for him. Govt. clinic will either treat him or find out exactly where and who to refer and also arrange vehicle and escort to accompany and quickly admit him there.
(46) To lay down guidelines (say 1 OPD clinic per 60000 people) for primary care in urban India – beginning with slums.
(47) To take steps to eradicate Truancy in Rural India.
· Affix attractive premium on a rural center commensurate with its remoteness etc.
· Provide housing etc. and seats for their wards in schools.
· Abolish ban on home district posting and seek volunteers.
· Panchayat to maintain an attendance register for the PHC.
Read the Order with respect to Public Interest Litigation (CWP (C) No.185 of 2007)