Mismanagement of tuberculosis in India: Causes, consequences, and the way forward

Abstract

India leads the world in its burden of tuberculosis (TB) due to the neglect of TB as a public health problem, and mismanagement of TB patients in both public and private sectors. The original National Tuberculosis Programme (NTP) failed because of low rates of case detection and cure. The Revised National Tuberculosis Control Program (RNTCP) has reversed these trends in the public sector, with expanded access to improved diagnosis, short-course regimens and high cure rates. The RNTCP is yet to adequately address the challenge of drug resistant TB. The private sector in India, which manages more than half of all TB patients, is a continuing source of mismanagement of TB, and is largely outside the scope of the RNTCP. Diagnostic and treatment practices in the private sector are often not evidence based. As RNTCP enters its new phase (2012 - 2017), there is an urgent need to engage, incentivize and integrate the private sector into national TB control, to facilitate universal access and to curb mismanagement of TB which threatens India's TB control efforts.