Threefold rise in budget to fight tuberculosis

India’s domestic budget for fighting tuberculosis showed a dramatic jump from about ₹700 crore in 2015 to ₹2,500 crore last year, according to a report from the World Health Organisation (WHO).

Typically most of India’s budget to combat the bacterial infection —that claimed 4.2 lakh last year—used to be dominated by international funding.

But, for the first time this has flipped. Domestic resources accounted for 74% of the $525 million spent in India last year, while it was only 38% in 2015.
In 2016, India recorded a 12% dip in the number of TB deaths from the previous year though the incidence dipped marginally by 1%.

The number of notified cases of drug-resistant tuberculosis (MDR-TB) jumped from 79,000 to 84,000 in 2016, pointing to the deployment of better diagnostics.

However, with 1.7 million new cases in 2016, India still continues to be the largest contributor to the global burden with up to a quarter of the 6.3 million new cases of TB (up from 6.1 million in 2015). Inspite of the dip, India accounts for about 32% of the number of people worldwide who succumbed to the disease.

The government has committed to achieve a ‘90-90-90 target’ by 2035 (90% reductions in incidence, mortality and catastrophic health expenditures due to TB). This is premised on improved diagnostics, shorter treatment courses, a better vaccine and comprehensive preventive strategies. In 2016, the WHO said that India had many more deaths and incidence of the disease than had been estimated over the years.

However, several activists say that inspite of the government commitments, TB is still stigmatized and under-reported — especially from the private sector — and top-line drugs are still inadequate to treat people who suffer from the drug-resistant forms of the disease.

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India Topped Global Tuberculosis Fatalities in 2016

Despite a reduced number of Tuberculosis deaths in 2016, India continued to have the highest TB casualty in the world. WHO’s Global Tuberculosis Report 2017 has recorded 4.23 lakh TB deaths (without HIV) in India, a slight dip from the 4.8 lakh deaths in 2015.
India alone has contributed to 33% of the total 1.04 crore global deaths due to TB (without HIV) and 26% deaths among HIV+ cases. Seven countries account for 64% of these deaths. India, with the highest casualty rate leads the pack of these seven nations, followed by Indonesia, China, Philippines, Pakistan, Nigeria and South Africa. However, mortality of TB patients with HIV in India has also dipped from 37,000 in 2015 to 12,000 in 2016.

Efforts put in across the world to combat the menace of Tuberculosis have saved an estimated 53 million lives since 2000 and the mortality rate has come down by 37% globally. Yet, TB remains the most killer infectious disease in the world.

The latest picture is one of a high burden of disease and progress that is not fast enough to reach targets. TB is the ninth biggest killer disease worldwide and the leading single infectious agent, ranking above HIV/AIDS.

A total of 19.36 lakh cases were notified in India in 2016, of which, 17.63 lakh cases were either new or relapse. This is up from 2015’s notifications of 17.4 lakhs. The treatment coverage of TB has gone up from 59% to 63%.

The WHO report also noted that India’s funding for TB has gone up from an annual budget of $280 million in 2015 to $525 million, which is quite a drastic growth. Domestic spending on TB has gone up from 32% of the annual budget to 74%, thus decreasing its dependency on international funding.

Of the 6,00,000 cases that have become resistant to the most effective first line drug — rifampicin — 47% are in India, China and the Russian Federation. India is one of the 14 countries to have the highest Multi Drug Resistant TB (MDR-TB), TB and HIV. The fact that 21% of MDR-TB deaths are in India, affects the figures of drug resistant diseases globally.

India, especially needs to close its gap between the incidence of TB and reported cases, as at 25%, it’s the highest in the world. Tuberculosis incidence is falling at about 2% per year. However, by 2020, it has to go up to at least 4-5% per year, to reach the 2020 goal of ‘End TB Strategy’.

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