Black hole in Under-Reporting of TB Cases in India

A recent research report citing wrong estimation of Tuberculosis (TB) case in the private sector in India has received global attention. The research paper published in the 25 August 2016 issue of Lancet Infectious Diseases Journal by the researchers at Imperial College of London suggests that 2.2 million TB patients are treated in India’s private sector alone in 2014. Interestingly, this new figure is 2 to 3 times higher than the current estimates. The government-led Revised National Tuberculosis Control Program (RNTCP) treated only 1.42 million TB cases during the same period. The findings of 2.2 million TB cases in private sector has come up after, researchers took into account the quantum of TB drugs sold in private sector during the study period. The under reported TB cases has brought to the light the deep rooted privacy existing in the reporting of TB cases within private sector in the country. This approach of not disclosing the number of cases treated in the private owned hospitals/clinics made it extremely difficult to estimate the burden of this disease. The common question hunts every concerned citizens- why private sector is so reluctant to notify TB cases to government’s system? Although TB was declared a notifiable disease in way back in 2012, private sector’s contribution to TB notification is estimated at record low at 5%. This low notification rate by private sector increases the chances of “missing cases” in the country. The number of missing cases has now reached to one million in India as per a WHO statistics. These number of “missing cases” essentially indicates that most of these people, who become ill with tuberculosis, have either not taken care at all, or died or there is possibility that most of them are treated in the private sector and hence comes under the “missed” category. It is a known fact in India that most of these patients, who are being treated at private sectors, do not necessarily report the details to the national TB program. Due to high medical cost in the private sector, most of the patients from poor economic strata discontinue the medicines before completion of the treatment. The new estimates of TB cases treated at private settings open up the Pandora box of how badly government has failed to convince private sector to notify this disease to the public system. There seem to be a serious trust-deficit among government and private players that comes up as a clear road blocks in bringing out a monitoring mechanism to estimate the burden of this infectious disease. The under reporting of TB cases in the private sectors has also brought serious challenges of fuelling drug resistant cases in the country. Finding that present TB number could possibly become the double/triple against what is currently estimated, there is an urgency before government to build up a formal mechanism to ensure treatment adherence and follow up of TB patients at private setting. This mechanism will possibly address treatment interruption, drug resistance and unfavourable outcomes like failure and death. The private sector in India is not a standardized entity –it ranges from unqualified providers to super specialists; from informal clinics in the rural areas to corporate hospitals in the urban locations. The multiplicity nature of private sector must be dealt with different strategies to involve this diverse group. The number of research have unearthed the absence of awareness regarding notification along with established misapprehensions that notification may bring unnecessary inspection related to clinical practice and income by government’s regulatory bodies. The government has to come up with a convenient mechanism to facilitate notification and follow up of TB patients at private sector. Once above measures are in place, it will be a win-win situation for all; the system received the notifications, the private entity ensured compliance for notification and retained the patients and finally the TB patients received health care and adherence support at no added cost.

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