As Centre urges citizens to share responsibility of TB care, mixed response from experts

Some accuse govt of outsourcing its responsibility towards TB patients; others call it a good idea in a resource-strapped country.

ByChetana Belagere

Published Sep 11, 2022 | 10:00 AM Updated Sep 11, 2022 | 10:00 AM

Doctor examining a TB patient

The two initiatives that the government launched on Friday, 9 September, to eliminate tuberculosis (TB) and support its victims have elicited a mix of flak and praise from doctors and stakeholders fighting the disease.

The broader verdict: The campaign against TB and the people suffering from it needs something more than catchy punchlines.

President Droupadi Murmu on Friday virtually launched the two programmes to contain TB.

The first, the Pradhan Mantri TB Mukt Bharat Abhiyan, is a drive to reinvigorate the mission of TB elimination from the country by 2025. The second, the Ni-kshay 2.0 initiative, is a portal for donors to provide various forms of support to people undergoing TB treatment.

What is Ni-kshay 2.0?

A crowdfunding model of sorts, Ni-kshay Mitra encourages individuals, private companies, NGOs, elected representatives, political parties, and various institutions to “adopt” TB patients and communities and become their “Nikshay Mitra” — a good friend.

Draupadi Murmu virtually launched the Ni-kshay Mitra initiative on Friday

President Draupadi Murmu virtually launched the Ni-kshay Mitra initiative on Friday. (Supplied)

The adopter is required to ensure nutritional support, medicines, diagnostic support, and vocational support for a minimum of one year.

The two programmes mark a continuation of Prime Minister Narendra Modi’s 2018 assertion that India would eliminate TB by 2025 — five years ahead of the global deadline of 2030 — a commitment he reaffirmed at the United Nations General Assembly in 2019.

Critics’ take

But critics questioned the measures being taken by the Modi government to contain the disease.

In fact, less than a third of the targeted population — around nine lakh of the estimated 27 lakh TB survivors — have agreed to be “adopted”. Only 13.5 lakh are even registered on this government portal as on Friday evening.

TB officials had begun the process of registration well before the launch, using their databases and seeking the consent of patients. With the official launch, now people who want to adopt can also register.

Dr Veena Shatrugna, former deputy director at the National Institute of Nutrition (NIN), Hyderabad, summed up the wider consensus among stakeholders, and called the “adoption scheme” a “mockery”.

“I have never heard of such an idea,” she told South First.

“How can a person who has zero knowledge about the requirements and complication of this disease just adopt a patient?”

Support for Ni-kshay Mitra

Experts identify undernutrition as a leading risk factor for TB, and the attempt under Ni-kshay to address this found pockets of support.

Ni-kshay Mitra launched as part of Pradhan Mantri TB Mukt Bharat Abhiyaan

Ni-kshay Mitra launched as part of Pradhan Mantri TB Mukt Bharat Abhiyaan/Union Ministry of Health and Family Welfare. (Supplied)

Dr Gagandeep Kang, renowned microbiologist from CMC, Vellore, felt the idea was not bad for a country that is perennially short of resources.

“It is a good way to go in a country like ours where we always fall short of resources, a programme like this makes sense,” she told South First.

“There have been studies done by my colleagues at CMC Vellore and we have also found that TB patients, with a year of nutrition programme, followed up continuously, have shown definite improvements in their health.”

She went on to add: “To put everything on the government is not right; there needs to be a balance in what we ask from the government. This method may work as long as there is a security of supply of interventions. We can’t expect the NGOs, and community volunteers to supply.”

How does the scheme work?

This is how the scheme works: People and groups registering themselves as adopters on the Ni-kshay 2.0 portal, https://communitysupport.nikshay.in, will need to finance the nutritional requirement of the patients they adopt.

As per the website, adult patients will be given a monthly food basket consisting of 3 kg of cereals and millets, 1.5 kg of pulses, 250 g vegetable cooking oil, a kilo of milk powder or 6,000 ml of milk, while children will get the same items but in lesser quantities.

The entire food basket is estimated to cost an adopter between ₹1,000-₹1,500 a month.

Dr Giridhara Babu from Karnataka, a renowned epidemiologist and public health expert, said this was a good move. “Although the government’s role is greater, but it cannot be successful without participation from the public, healthcare community and civil society,” he told South First.

But Dr Babu also had a word of caution. “Sustainability of this programme depends on how well it connects people with resources, and also how well the importance of nutritional supplementation is conveyed to the public.”

Not everyone is convinced

Critics are not totally convinced. In fact, said Dr Shatrugna of NIN, “The government of India has unfortunately always highlighted the wrong approach.” Maintaining that “TB is not a simple illness”, she emphasised that it had side-effects, and needed a long-term treatment.

“Regular availability of drugs must be monitored,” she said. “Moreover, poverty needs to be addressed. The modalities of delivering the food are very complicated. Patients are going to become beggars if they already aren’t.”

Bhopal-based Anant Bhan, the immediate past president of the International Association of Bioethics and an adjunct professor at Yenopaya College in Mangaluru, is only half convinced, saying all that the scheme ensured was “more services for a higher number” of patients.

“But there is a drawback to this approach,” he told South First. “It takes a charity approach to the provision of TB care.”

Bhan said TB being a “public health priority” for India, public resources should have been earmarked for the programme. “We should not have to depend on individual donors to provide food baskets,” he said.

‘Fight poverty to fight TB’

Prasanna Saligram of the Bengaluru-based Jan Swasthya Abhiyan (People’s Health Movement), who has worked with TB patients, said the new schemes exposed the government’s failure to take responsibility for TB victims.

“The emphasis on individuals/groups taking care of a patient’s nutrition is very ironic,” he said. “It shows the state doesn’t see itself as a provider.”

Saligram also referred to the Nikshay Poshan Yojana programme launched in 2018, which aimed to provide an incentive of ₹500 for nutritional support to TB patients. “How many of them are actually availing of this?” he asked.

And like Dr Shatrugna, he stressed on the need to fight poverty in order to fight TB.

“Without addressing poverty, such adoption schemes won’t work,” he said categorically.