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12th June 2024 (12 Topics)

Financial Hardship in TB Treatment Programme

Context

A recent survey sheds light on the significant financial challenges faced by TB patients in India. The survey, encompassing 1,482 TB patients across four states, reveals alarming levels of economic hardship resulting from delays in diagnosis and the long course of TB treatment.

Key-findings of the Study

  • Financial Strain: TB patients experience the severe financial strain, with delays in diagnosis and loss of income during treatment contributing to substantial economic burdens.
  • Catastrophic Costs: Between 30% to 61% of study participants faced catastrophic costs, defined as out-of-pocket expenses exceeding 20% of pre-TB annual household income. These costs pose a significant threat to the financial stability of TB-affected households.
  • Pre-Diagnosis Delay: Over half of the participants faced catastrophic costs even before commencing TB treatment due to delays in diagnosis. The average delay of seven to nine weeks from symptom onset to treatment initiation significantly contributed to financial burdens.
  • Recommendations: The survey recommends
    • intensifying private sector engagement
    • improving rapid diagnosis
    • implementing community awareness campaigns
    • expanding health insurance coverage for pre-treatment expenses
    • safeguarding TB patients from income loss

How ‘cost’ is a determining factor in TB treatment?

  • TB treatment in India often imposes a significant financial burden on patients and their families due to various factors, including medical expenses, loss of income, and associated costs.
  • Patients face a range of other recurring costs including the costs of accommodation, transport to healthcare facilities and consultations, multivitamins, and loss of income due to missed work
  • Other Challenges:
  • Delays in Diagnosis: Widespread delays in diagnosing TB persist due to various factors, including delayed testing and reliance on older diagnostic methods like smear microscopy.
  • Diagnostic Gaps in Rural Areas: The availability of tools to diagnose extra-pulmonary TB, especially in rural areas, remains a significant gap in healthcare infrastructure.
  • Barriers to Treatment Adherence: Poverty, lack of awareness about TB, and shortages of medication contribute to patients discontinuing treatment prematurely.

Case Study

  • In 2022, Tamil Nadu launched India's first special TB care model, known as the Tamil Nadu-Kasanoi Erappila Thittam (TB death-free project).
  • This initiative aimed to reduce deaths among TB patients aged 15 and above by 30%.
  • The program assessed newly diagnosed TB patients to identify those with severe malnutrition or respiratory issues, referring them for hospitalization when needed.
  • One in four patients assessed were found to be severely undernourished.
  • Scaling up such initiatives could help prevent TB-related deaths.
What measures are required?
  • The findings of the survey underscore the urgent need for both policy and public interventions to alleviate the economic burden of TB on patients and the nation.
  • Addressing delays in diagnosis, ensuring uninterrupted livelihood during treatment, and expanding health insurance coverage are essential steps towards mitigating catastrophic costs for TB-affected households.
  • Furthermore, enhancing private sector engagement and community awareness campaigns can facilitate timely diagnosis and treatment initiation, reducing financial hardships associated with TB.
Fact Box: About Tuberculosis (TB)
  • Causes: TB is caused by a bacterium known as Mycobacterium tuberculosis, which is a member of the Mycobacteriaceae family comprising approximately 200 species.
  • Types of TB:
    • Pulmonary TB (affecting lungs)
    • Extra-pulmonary TB (other organs outside lungs)
  • Treatability and Curability: TB is a treatable and curable disease, especially when diagnosed early and treated promptly with appropriate medications.
  • Mode of Transmission: TB spreads from person to person through the air, particularly when individuals with lung TB cough, sneeze, or spit.
  • TB Mukt Bharat (TB-free India): India is committed to ending the TB epidemic by 2025, five years ahead of SDG target timeline. (India accounts for around 27% of TB cases worldwide – which is the world’s highest country-wise TB burden)
  • National and international initiatives:
    • National TB Elimination Programme (NTEP)
    • National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025)
    • The Nikshay Ecosystem (National TB information system)
    • Nikshay Poshan Yojana (NPY- financial support)
    • TB Harega Desh Jeetega Campaign
    • TB Free India Campaign
    • Tribal TB Initiative

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