Lok Sabha Question No. 2589 (UNSTARRED), answered on 2020-03-06
Subject: Eradication of TB
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Ranjeetsingh Naik Nimbalkar, Jagdambika Pal, Pallab Lochan Das, Ramdas Chandrabhanji Tadas, Sangamlal Kadedin Gupta

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

LOK SABHA UNSTARRED QUESTION NO. 2589 TO BE ANSWERED ON 06 TH MARCH, 2020

## ERADICATION OF TB

## 2589. SHRI RANJEETSINGH HINDURAO NAIK NIMBALKAR:

SHRI JAGDAMBIKA PAL:

SHRI PALLAB LOCHAN DAS:

SHRI RAMDAS C. TADAS:

SHRI SANGAM LAL GUPTA:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a)  whether  the  number  of  cases  of  Multi  Drug  Resistant  (MDR)  TB  have  increased  in  t country,  if  so,  the  details  thereof  indicating  the  number  of  Tuberculosis  (TB),  MDR - TB  and XDR - TB patients in the country, State/UT - wise;
- (b) the steps taken to tackle antibiotic resistance and drug resistant TB through interv awareness;
- (c) whether the Government has declared to make India TB free by 2025, if so the details and the time by which the National Strategic Plan (NSP) 2017 - 25 for eradication of TB is likely to become operational;
- (d) whether as per the NSP certain sha re of funds for NSP is to be utilized for the social welf schemes,  if  so,  the  details  thereof  and  the  mechanism  formulated  to  ensure  inter - ministe ial coordination for connecting TB programmes and the social welfare schemes; and
- (e) the other provisio ns made/steps taken by the Government to eliminate Tuberculosis?

## ANSWER

## THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a): No, the estimated number of Mulit - Drug Resistant (MDR)/ Rifampicin Resistant (RR) TB patients has reduced from 147000 in 2017 to 135000 for the year 2018 as per the latest Global TB report. However, the number of MDR patients diagnosed is increasing due to incr in  availability  of  diagnostic  facilities  and  proportion  of  TB  patien ts  being  screened  for  the presence of drug resistance. With the implementation of the Revised Diagnostic Algorithm countrywide  Universal - Drug  Susceptibility  Test  (DST)  in  2018,  all  patients  diagnosed  wit tuberculosis are being offered rapid molecular diagnostic tests for detection of drug resistance, further  leading  to  increased  detection  of  Drug  Resistant  (DR)  TB  cases. The  number  of tuberculosis (TB) MDR -TB and XDR - TB patients in the country, State/ UT wise is enclosed at Annexure.

(b): Following steps have been taken to tackle drug resistant TB::

1. Expansion  of  molecular  diagnostics  across  country  for  rapid  detection  of  dr resistance  and  linkage  with  treatment  and  adoption  of  new  diagnostics  lik TRUNAT
2. NTEP provides drug susceptibility guided treatment for all notified TB patients and guidelines  are  revised  as  and  when  needed  based  on  in  country  and  internation evidence
3. Patient support systems are in placed under the programme to ensure completion o treatment  which  includes  patient  co u seling,  travel  reimbursement,  incentive  for patients and provider.
4. States/Districts  are  provided  with  IEC  budget  for  community  meeting,  patien provider meeting and other awareness activities for adopting cough etiquette, pat education and prevention.
5. Airborne  infection  control  measures  are  being  implemented  in  drug  resistant wards.

(c ):  The Ministry has set a goal of elimination of TB in the country by 2025, five year the global targets. The National Strategic Plan (2017 - 25) for TB elimination was approved by Hon'ble Minister for Health and Family Welfare on 8 th May 2017 and has been operational since then in the entire country with the goal of Ending TB by 2025.

(d): Under the National Strategic Plan (NSP) for Tuberculosis (2017 - 2025), 20%, 22% and 24% of the funds have been earmarked for social welfare support in years 2017 - 18, 2018 -19 and  2019 - 20  respectively.  This  includes  funds  for  nutrition  support  for  TB  patients,  t reimbursements for tribal patients and honorarium for treatment supporters.

|                           | 2017- 18   | 2018- 19   | 2019- 20   |
|---------------------------|------------|------------|------------|
| Amount (In crores)        | 612.60     | 907.53     | 1223.94    |
| As % of total budget      | 20%        | 22%        | 24%        |
| Total NSP proposed budget | 3135.61    | 4115.64    | 5075.95    |

The  Ministry  has  established  an  Inter - Ministerial  Coordination  committee  under  the chairpersonship of Secretary (Health and Family Welfare) for smooth linkages between link between the TB programme and various ministries like Ministry of Tribal Affairs , Ministry of Women and Child Development, Ministry of Social Justice & Empowerment and Ministry of Labor & Employment.

Contd……..

| (e):   | 1. The Ministry has developed the National Strategic Plan (NSP) for Tuberculosis (2017-2025) with the goal of ending TB by 2025. 2. Early diagnosis of all the TB patients, prompt treatment with quality assured                                                                                                                                                                                            |
|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|        | drugs and treatment regimens                                                                                                                                                                                                                                                                                                                                                                                 |
|        | 3. Private sector engagement to increase notification and provision of public health action. Ensuring availability of free diagnostics and medicines from the Programme to patients seeking care in the private sector as well. MoU has been signed with Indian Medical Association (IMA), Public Private Support Agency interventions have been initiated through JEET (Joint Effort for Elimination of TB) |
|        | 4. TB elimination efforts are being closely monitored through Nikshay portal.                                                                                                                                                                                                                                                                                                                                |
|        | 5. Various patient support systems like Nikshay Poshan Yojana, Provider incentive                                                                                                                                                                                                                                                                                                                            |
|        | and informant incentive rolled out 6. For TB patient community participation and voice, >90% districts                                                                                                                                                                                                                                                                                                       |
|        | have established TB forum in the country.                                                                                                                                                                                                                                                                                                                                                                    |

…………………

No. of MDR and XDR TB patients diagnosed in 2019

| State                     |   No. of MDR RR diagnosed in 2019 |   No. of XDR diagnosed 2019 |
|---------------------------|-----------------------------------|-----------------------------|
| Andaman & Nicobar Islands |                                37 |                           0 |
| Andhra Pradesh            |                              2278 |                          16 |
| ArunachalPradesh          |                               190 |                           0 |
| Assam                     |                               917 |                           6 |
| Bihar                     |                              4242 |                         163 |
| Chandigarh                |                               111 |                           1 |
| Chhattisgarh              |                               443 |                          13 |
| Dadra & Nagar Haveli      |                                20 |                           0 |
| Daman & Diu               |                                19 |                           1 |
| Delhi                     |                              2485 |                          57 |
| Goa                       |                                48 |                           0 |
| Gujarat                   |                              3962 |                         115 |
| Haryana                   |                              2078 |                          34 |
| Himachal Pradesh          |                               326 |                           3 |
| Jammu & Kashmir           |                               183 |                           1 |
| Jharkhand                 |                              1053 |                          24 |
| Karnataka                 |                              2054 |                          45 |
| Kerala                    |                               258 |                           8 |
| Lakshwadeep               |                                 0 |                           0 |
| Madhya Pradesh            |                              3909 |                          85 |
| Maharashtra               |                             10621 |                         670 |
| Manipur                   |                               132 |                           0 |
| Meghalaya                 |                               321 |                          22 |
| Mizoram                   |                               130 |                           0 |
| Nagaland                  |                               144 |                           2 |
| Odisha                    |                               683 |                           7 |
| Puducherry                |                                12 |                           1 |
| Punjab                    |                               940 |                          22 |
| Rajasthan                 |                              4252 |                         127 |
| Sikkim                    |                               238 |                          10 |
| Tamil Nadu                |                              1913 |                          15 |
| Telangana                 |                              2017 |                          49 |
| Tripura                   |                                32 |                           1 |
| Uttar Pradesh             |                             16479 |                         666 |
| Uttarakhand               |                               741 |                          34 |
| West Bengal               |                              3068 |                         124 |
| Grand Total               |                             66336 |                        2322 |

## Annexure