Addressing poverty through disease control programmes: examples from Tuberculosis control in India

Abstract

IntroductionTuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor.MethodologyA national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India.ResultsResults revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear.ConclusionFurther in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.

Tendência da mortalidade por tuberculose no estado do Paraná, Brasil – 1998 a 2012

“…Currently, India is the country that concentrates the largest number of cases of tuberculosis in the world, that is, 21% of all new cases. For being a country with extreme differences, it is clear that socio-economic determinants amplify inequities in health, affecting mainly vulnerable groups 30 . Moreover, it should be noted that the HIV/Tb co-infection has great influence on deaths, since it is preconized that all patients diagnosed with tuberculosis should undergo HIV testing, which does not happen during most of the services provided.…”

The High Cost of Free Tuberculosis Services: Patient and Household Costs Associated with Tuberculosis Care in Ebonyi State, Nigeria

“…This led to long delays in treatment-seeking pathways before a proper diagnosis was made. Inefficiencies in public health facilities and lack of pro-poor TB control services at rural private facilities were two main constraints responsible for prolonged delay and increased cost of TB diagnosis [10], [13], [24], [28]. The rural poor are left with the private facilities who often charge user fees and other fees.…”

Relationship between Nutritional Support and Tuberculosis Treatment Outcomes in West Bengal, India

“…In studies from India, the impoverished were twice as likely to have TB, three times less likely to access TB care, four times less likely to complete anti-tuberculosis treatment, and more likely to incur impoverishing payments for TB care than the non-impoverished [12] [13]. The risk of mortality during anti-tuberculosis treatment among severely undernourished patients was double that of non-undernourished patients in rural and central India [14].…”