At the Brunt of Tuberculosis

More than a quarter of all cases of tuberculosis (TB) reported worldwide are found in India. According to estimates of the World Health Organization’s Global TB Report 2016 (released on 13 October 2016), 2.8 million out of 10.4 million new cases of TB in the world are in India. This comes close on the heels of a study published in the Lancet in August 2016, which created a stir with its estimation of the number of TB cases treated in India’s private healthcare sector itself at 2.2 million, two to three times higher than previous estimates, in addition to the 1.4 million cases treated in the public sector under the Revised National Tuberculosis Control Programme (RNTCP). More importantly, the study reiterated the importance of data surveillance for the public health system in India and its lack thereof.

The first national anti-tuberculosis drug resistance survey was launched in 2014. Unfortunately, this opportunity was not used to conduct a much-needed comprehensive national-level survey that would cover incidence, prevalence, diagnosis, treatment, mortality, socio-economic factors, etc, in addition to drug resistance. Given that the last national-level TB survey was done by the Indian Council of Medical Research in 1955–58—making our baseline data on TB more than 50 years old—the only regular source of national-level TB data is from the RNTCP. This is limited only to TB patients registered with the programme, hence excluding those not registered, or not reported by the private healthcare sector, not to speak of those not having been diagnosed or having been misdiagnosed—the “missing millions.”