India: Acute shortage of TB medicines in UP
LUCKNOW: Shortage of essential tuberculosis medicines in government-run centres in state has made it extremely difficult for patients. Sources in health department said there was absolutely no stock of medicines for first line treatment of TB and that less than 1% of medicines needed for treating multi-drug resistant TB (MDRTB) are available. In fact, the 1,000 patients of MDRTB cannot be provided with all the seven medicines they need. One drug or the other would be missing in their kit. Incidentally, patients suffering from extremely drug resistant TB (XDR) are left to fend for themselves as the Health department has not initiated the process to procure medicines they need. One week's medicine bought from the market costs around Rs 2,000, a price the poor can ill afford.
Making matters worse is the non-availability of funds with the health department. As a result, a large number of contractual staff have not got their salaries since April. The staff includes DOTS (directly observed treatment-short course) motivator who ensures that a TB patient takes medicines on time. It is feared that if funds or medicines do not arrive by mid-September, the programme may close.
Unavailability of TB control medicines in UP is criminal considering there are more than 2.71 lakh TB patients in the state, including 13,693 children enrolled in the TB control centres at various government hospitals and medical colleges. The prevalence of TB in state is higher than the national average. As per the TB India report 2013, the prevalence of TB in India is around 18% while that for UP is 22.35%.
The scenario could be worse than what has been highlighted in the report. "What ever is being assessed is done through the data gathered from the government health facilities which attend to only 30% of the TB cases. The remaining go to private doctors who are supposed to notify the government. But since the inception of an order in May 2012 that made notification mandatory, UP has notified some 1,000 patients," said an activist adding, "once the private sector database develops, the prevalence is sure to surge."
Statistics in the report also indicate that the rate of sputum positive (of people with infective TB who may spread the disease to people around them) cases in UP is higher. Against a national average of 11%, sputum positivity rate for UP is 14.6%. If care is not taken, then the general TB cases would develop MDRTB. "A TB patient missing medicines slowly inches towards resistant TB besides exposing his caregiver and the community (1,000 persons around him) at the risk of disease," said Dr BP Singh, a city-based private practitioner.
The deficit has already started showing up. State's rate of reduction (in number of TB positive patients) has gone down from 6% in the first quarter to 4% in the second. The rate of referral (number of suspects who should be examined per 1 lakh population) of suspected cases has also decreased. In July, it stood at 153 / lakh compared to 156/lakh in July 2012. This is significant as UP much behind the WHO standard of 180 cases/lakh. The state also recorded a drop of 6% in the number of suspected cases.
Officials at ministry of health and UP health department have been intimated about the crisis and mud-slinging is on. A health ministry official blamed UP for the crisis. "Funding for all national programmes is done through NRHM. But the grant sanctioned has not been released as the state failed to submit complete audit reports and provide utilisation certificates against expenditure made in previous years," said one of them. But the health officials blame the centre for it. "Ministry of health procures medicines and supplies them to four drug stores from where it goes to the districts," said an officer in UP.
Sources attributed the crisis to delay in tender process for procurement of medicines. "The tender was to be floated in 2011 but was stuck. The process gained pace in June 2013. The supply-chain is being restored. Release orders of medicine have been issued in some states but it will take at least 6-7 weeks for the stocks to actually reach the ground," said an officer in the state government.
The state,however, cannot keep its corners clean. The programme is yet to get its due. It is being headed by Dr SK Tewari who is on long leave. "I have not been keeping well for the last few months, so I am on long leave," he told TOI. There is a 37% gap in trained key staff positions across the board. Infrastructural gaps such as shortage of designated microscopy centres where TB patients can go for testing also limits the reach of the programme. UP needs 2,000 such centres while 1,850 are available.
Health activists working against TB are not ready to accept that the programme of such immense importance suffers due to a sick official. "Is he the only person available in the entire health directorate to take care of such an important responsibility? I think the health department is yet to realise the importance of the programme which is associated with the health of over 2.75 lakh patients at any given point in time," said Bobby Ramakant who is associated with 'Vote for Health' campaign.
TOI contacted officiating STO, Dr Alok Ranjan, who said, "So far, we have been using our buffer stock. But now, the crisis has deepened. We have apprised the state government besides writing to the ministry. I hope the problem will be sorted soon."
Source:
The Times of India
