Lok Sabha Question No. 3061 (UNSTARRED), answered on 2019-12-06
Subject: TB Cases in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: Heena Vijaykumar Gavit, A.K.P. Chinraj, Ratansinh Magansinh Rathod, Shrirang Appa Barne, Vinayak Bhaurao Raut

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

## LOK SABHA UNSTARRED QUEST ION NO. 3061 TO BE ANSWERED ON 6 TH DECEMBER, 2019

## TB CASES IN RURAL AR EAS

## 3061. DR. HEENA GAVIT:

SHRI VINAYAK RAUT:

SHRI SHRIRANG APPA BARNE:

SHRI RATANSINH MAGANSINH RATHOD:

SHRI A.K.P. CHINRAJ:

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

- (a) whether TB cases in rural and backward areas are increasing at an alarming rate and i t otal  number  of  TB  cases  reported  in  the  country  especially  in  remote  villages  and dominated areas during the last three years and the current year;
- (b) the reasons for failure to control TB in rural villages and tribal areas along with being faced by the Government to control TB;
- (c) whether the Government has created any awareness among people affected with TB to g treatment in hospitals, if so, the details thereof along with the funds allocated for this
- (d) whether the Government has launched 'TB Harega, Desh Jeetega' campaign with a target of becoming TB free India before 2025, if so, the details thereof along with the various m being taken in this direction;
- (e) whether the Government is likely to extend f ree - of - cost and high - quality treatment in private and public hospitals and if so, the details thereof; and
- (f) whether TB patients are also extended monthly stipend per month for nutritional ass during  the  TB  treatment  throughout  the  country  under the  Nikshay  Poshan  Yojana  (NPY) indicating the number of beneficiaries benefitted so far along with the other steps being the Government to improve and expand the reach of TB care services across the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE

(SHRI ASHWINI KUMAR CHOUBEY)

- (a):The overall TB incidence in India is on the decline, 217 per lakh in 2015 to 199 per in 2018. The estimated burden of the disease has decreased from 28.4 lakhs in 2015 to 26.9

lakhs  in  2018. Country  achieved  Millennium  Development  Goals  (MDGs)  related  to Tuberculosis in 2016 -Incidence of TB declined by 28% since 1990.

Reporting of TB cases is increasing because of easy availability, accessibility of T B diagnost c centers in rural areas and tribal areas.

| Year                 | Number of TB patients in and tribal   | rural Total No. of TB patients   |
|----------------------|---------------------------------------|----------------------------------|
| 2017                 | 4,70,185                              | 18,27,959                        |
| 2018                 | 9,05,246                              | 21,52,279                        |
| 2019 (Till November) | 11,59,329                             | 21,46,288                        |

(b): The overall TB incidence in India is on the decline. TB control is also rapidly ga momentum  in  rural  areas  because  of  the  easy  availability  of  microscopy  center  as  per Government's decision to establish Designated Microscopy Centres (DMCs) in all Peripheral Health  Institutions  (PHIs)  as  per  the  need.  As  per  the  recent  norms,  one  DMC  caters population of 1 lakh. These norms are relaxed for tribal/hilly/difficult areas where on per 50,000 population is available.

The total number of DMCs h as increased from 16,600 in 2017 to 20,045 currently.

Huge thrust is being given to the transport of sample for easy accessibility of rapid mo tests to people in the rural areas. All DMCs have been made sputum collection centres necessary packag ing and logistic support has been made available. The Govt has establishe mechanisms  to  enable  sputum  transportation  through  India  Post  in  addition  to  other  l mechansims  such  as  MoU  with  courier  agencies,  human  carriers,  and  private  sector/NGO support .

Special Active Case Finding campaign of house to house search for TB cases is being carr out among vulnerable population mapped.

Because of these efforts, the number of TB patients diagnosed in the rural villages an tribal areas has increased fr om 4,70,185 in 2017 to 9,05,246 in 2018, and 11,59,329 in 2019.

The  Programme  has  further  taken  measures  to  reduce  stigma  of  TB  in  the  community. National,  state  and  district  level  forums  have  been  set  up  to  provide  a  platform  f survivors to voice the ir views.

Network  of  TB  Champions  have  been  created  from  existing  network  of  4  lakh  treatment supporters  and  past  TB  patients  and  people  affected  due  to  TB.  With  this  purpose standardized  curriculum  has  been  developed  to  support  TB  Survivors/  to  become effective Community TB Mobilizers/Champions.

More than 90,000 community members including TB survivors have been sensitized by 305 trained  TB  Champions  in  140  districts  in  collaboration  with  REACH  (NGO).  These  TB Champions have also provided patient suppor t services to more than 8000 TB patients.

To  strengthen  the  decentralized  functioning  of  TB  care,  the  Programme  is  also  provid 'informant incentive' of Rs. 500 and incentive for treatment outcome reporting - Rs. 1500 for Drug Sensitive TB (DSTB) patients and Rs. 5000 for Drug Resistant TB (DRTB) patients, including to ASHAs.

Further,  all  Health  &  Wellness  Centres  established  under  Ayushman  Bharat  have  been earmarked as sputum collection centres and DOTS centres from where TB medicines can be taken.

(c): Government of India has launched 'TB Harega Desh Jeetega Campaign' on 25 th Sept. 2019 in which new sets of IEC materials (in which it is clearly mentioned that 'Free diagnosis, Free treatment and Nutritional support are available to all Government Hospit als') have been launched and shared with States/UTs for further dissemination.  The funds amounting to 23.07  crores  have  been  allocated  for  Advocacy  Communication  and  Social  Mobilization (ACSM) activities for the year 2019 - 20 at the Head Quarters and R s 35.74 crores have been allocated for activities for the states.

## (d):   TB Harega, Desh Jeetega' campaign was launched recently with the objectives of

- Promoting health seeking behaviour in the community for early case detection

- -Preventing emergence of new cases of TB

An  'Accelerator  to  National  Strategic  Plan'  includes  following  key  components  under  'TB Harega, Desh Jeetega' campaign:

1. Community Engagement
2. Advocacy and Communication
3. Health & Wellness centres and TB
4. Inter - Ministerial collaboration
5. Private health sector engagement
6. Corporate sector engagement
7. Latent TB Infection Management

(e):  The Revised National TB Control Programme provides free treatment to all TB patient the country, irrespective of the sector from which the patient is se eking care. The Programme has made provisions under which private sector health centres can also serve as DOTS Cent and provide RNTCP supplied daily FDC drugs to TB patients.

(f):   Since April 2018, all TB patients are covered under the Nikshay Poshan Yojana scheme, at the rate of Rs. 500 per month for their entire duration of treatment. Till 30 th October 2019, approximately 28 Lakh beneficiaries have been paid approximately Rs. 450Cr.

The Programme provides quality drugs and free diagnostis to all notified TB patients in the public and private sectors.

The Govt. has taken several other measures to expand the reach of TB care services:

- i. Active Case Finding (ACF) in vulnerable and high risk populations to actively sc symptomatics and detec t TB patients.
- ii. Private sector engagement to increase notification and provision of public health Ensuring availability of free diagnostics and medicines from the Programme to pati seeking care in the private sector as well. MoU has been signed with Indian Medical Association  (IMA),  Public  Private  Support  Agency  interventions  have  been  initia through JEET (Joint Effort for Elimination of TB)
- iii. Strengthening sputum collection and transport mechanisms to ensure early diagnosis. Programme hasalso tied up with India Post to increase access. Other mechanisms bei strengthened at the local level involve MoUs with courier agencies, human couriers.
- iv. Increasing  the  network  of  rapid  molecular  diagnostics  to  ensure  detection  of resistance at the earliest. The Programme has rolled out Universal Drug Susceptibilit Testing (UDST) since 2018 as per which resistance testing for Rifampicin is mandat for all notified TB patients.
- v. Communication  campaign  aimed  at  raising  levels  of  awareness,  reduction of  stigma among community, both through mass and mid media.
- vi. To reduce stigma of TB in the community, National, state and district level for have been set up to provide a platform for TB survivors to voice their views. Netw of  TB  Champions  have  been created  from  existing  network  of  4  lakh  treatment supporters and past TB patients and people affected due to TB. With this purpose standardized  curriculum  has  been  developed  to  support  TB  Survivors/  to  become effective  Community  TB  Mobilizers/Champions. More  than  90,000  community members including TB survivors have been sensitized by 305 trained TB Champions in 140 districts in collaboration with REACH (NGO). These TB Champions have also provided patient support services to more than 8000 TB patients.
- vii. Further, all Health & Wellness Centres established under Ayushman Bharat have bee earmarked as sputum collection centres and DOTS centres from where TB medicines can be taken.
- viii. Inter - Ministerial coordination through signing of MoUs with the Ministeries of D efence, Railways, and AYUSH has enabled the Programme to extend TB care services through the hospitals and dispensaries running under these Programmes, and also widened scope of IEC activities for increasing TB awareness.

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