In a bid to incentivise States to move towards a tuberculosis-free status, the Centre has floated a plan under which they will receive up to ₹1 crore in cash if they bring down their patient caseload.

“If a State brings down its TB incidence by 80 per cent, we will award them ₹1 crore. Similarly, if the incidence reduces by 60 per cent, they will be paid ₹75 lakh, while a 40 per cent reduction will attract a prize of ₹50 lakh, and a 20 per cent reduction will see an infused additional funding of ₹25 lakh,” said Vikas Sheel, Joint Secretary, Ministry of Health and Family Welfare (MoHFW).

The MoHFW is encouraging the districts to work towards decreasing the TB burden, too. They will be paid ₹10 lakh for an 80 per cent reduction, ₹5 lakh for 60 per cent, ₹3 lakh for 40 per cent and ₹1 lakh for 20 per cent, Sheel said.

“By March 2021, we are confident that all the districts will reduce the incidence of TB by at least 20 per cent. Betul district in Madhya Pradesh has committed to as much as a 60 per cent reduction by 2021. This is encouraging,” he added.

Ranking system

In order to track State-wise performance in TB elimination, the Centre has introduced a ranking system. Bihar has been ranked at the bottom-most position, with a score of 57.19, while Gujarat was at the top with a score of 85.09.

Four States — Uttarakhand, Rajasthan, Uttar Pradesh and Bihar — scored below 70, while the top-performing States, with a score above 80, are Gujarat, Himachal Pradesh and Andhra Pradesh.

While Kerala has committed to end TB by 2020, Himachal Pradesh has stated it will achieve this status by 2021. Sikkim and Lakshadweep have set a 2022 target, while Chhattisgarh, Jammu and Kashmir, Madhya Pradesh, Tamil Nadu, Bihar and Jharkhand have come on board for a 2025 deadline.

There are various indicators under which the States are analysed for the scores. These include the number of patients notified, TB patients with known HIV status, treatment success rate, provision of nutrition, direct benefit transfer, initiation of multi-drug resistant treatment, expenditure, and children’s treatment.

There are an estimated 26 lakh TB patients in India, according to the WHO, of which 23.98 lakh were registered with the MoHFW in 2019. “Three lakh patients are still missing. We are trying hard to bridge this gap,” said Sheel.

What’s elimination 

K Sachdeva, Deputy Director General at the Central TB Division, said that ‘elimination’ implies reducing the cases to such a number that it is no longer a public health threat. “This will mean that the case reduction will have to come down to 80 per cent in 2025, against what it was in 2015,” explained Sachdeva.

“This a challenge. Currently, annually, up to 4.4 lakh patients, according to WHO estimates, are dying in India, and we are able to track only up to 60,000 deaths. The management of TB in hard-to-reach areas, urban slums, and among migrants, remains a challenge. Also, addressing workplace discrimination, and addressing poor outcomes in drug resistant patients, needs to be tackled,” said Sheel.

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