Lok Sabha Question No. 631 (UNSTARRED), answered on 2018-07-20
Subject: Eradication of Tuberculosis
Ministry: HEALTH AND FAMILY WELFARE
Asked by: VIJAY KUMAR HANSDAK, ASHOK MAHADEORAO NETE, ELUMALAI VELLAIGOUNDER, MANOJ KUMAR TIWARI, A.T. (NANA) PATIL

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

## LOK SABHA UNSTARRED QUESTION NO. 631 TO BE ANSWERED ON 20 th JULY, 2018

## ERADICATION OF TUBER CULOSIS

## 631. SHRI VIJAY KUMAR HANSDAK:

SHRI ASHOK MAHADEORAO NETE:

SHRI V. ELUMALAI:

SHRI MANOJ TIWARI:

SHRI A.T. NANA PATIL:

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

- (a) whether the Government has conducted any survey on Tuberculosis (TB) and Multi - Drug Resistant TB (MDR TB) cases and attributable deaths reported in the country;
- (b) if so, the details thereof and the steps taken/proposed to be taken by the Government for identification,  detection and  treatment  of  TB/MDR - TB/  XDR - TB cases  along  with  the  funds allocated for the same, State/UT - wise;
- (c) whether the Government has finalized an aggressive national strategy to end Tuberculosis by 2025 and if so, the details thereof along with targets achieved so far; and
- (d)  the  other  measures  taken/being taken  by  the  Government  fo r  eradication f  TB  in  the country?

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

(SHRI ASHWINI KUMAR CHOUBEY)

- (a)& (b) : Yes. The  Ministry  of  Health  &  Family  Welfare  (MOHFW)  has  conducted  a survey on Drug Resistant TB during 2014- 17 and the final report of this survey was published on 24th March 2018. The survey indicated that the Multi Drug Resistant TB ( MDR - TB) is 6.19% (CI 5.54 -6.90%) among all TB patients with 2.84% (CI 2.27 -3.50%) among new and 11.60% (CI 10.21 -13.15%) a mong previously treated TB patients.

The  Ministry  is  planning  to  conduct  a  National  TB  Prevalence  Survey  (2018 - 20)  for estimation  of  Tuberculosis  prevalence  at  national  and  state  level.  The  Survey  will  be Indian  Council  of  Medical  Research  (ICMR) in  collaboration  with  Central  TB  Division  with technical support from WHO India.

For attributable deaths, estimation has been done by Global Burden of Diseases (G India)  lead  by  ICMR,  Institute  of  Health  Metrics  and  Evaluation  (IHME)  and  Public  Hea Foundation of India (PHFI) in collaboration with MOHFW and WHO. The report was released on 14th November 2017 and 3.2% of death and disability is attributed to TB in India.

The MOHFW has taken several new initiatives for strengthening early de tection and treatment of Tuberculosis in the country as under:

- 1) Gazette notification for mandatory reporting of TB cases to the Government.
- 2) Private sector engagement through various innovative models.
- 3) Active Case Finding for reaching the unreached vulnerabl e population.
- 4) Expansion of molecular diagnostics i.e. Cartridge Based Nucleic Acid Amplification (CBNAAT) for early diagnosis of Drug Resistant Tuberculosis (DR - TB).
- 5) Introduction  of  daily  regimen  for  treatment  of  drug  sensitive  Tuberculosis  acros country.
- 6) Introduction  of  Universal  Drug  Susceptibility  testing  for  all  diagnosed  TB  pat including patients from the private sector.
- 7) Introduction and scale up of Newer anti TB drug i.e. Bedaquiline for drug resista treatment.

State - wise  /  UT  wise  funds  allocated  for  Revised  National  Tuberculosis  Contro Programme (RNTCP) is enclosed as Annexure.

## (c) : Y es. The Ministry has formulated a National Strategic Plan (NSP) for Eliminatio TB (2017- 25).

In addition to the existing strategies under RNTCP, the NSP focuses on :

- Early diagnosis of all the TB patients, prompt treatment with quality assured dru treatment regimens.
- Suitable patient support systems to promote adherence.
- Engaging with the patients seeking care in the private sector.
- Prevention strategies including active case finding and
- Contact tracing in high risk / vulnerable population
- Airborne infection control.
- Multi sectoral response.

The key achievements under the NSP in 2017 - 18 are as under:

- All TBpatients are offered Free Drugs and Diagnostics.
- 1135 CBNAAT machines have been installed and made functional.
- In 2018 from 1 st January to 30 th June, 2018, a total of 10,01,918 TB patients have been notified out of which 2,40,314 patients have been notifi ed from the private sector.
- Shorter regimen for treatment of drug resistant TB patients has been initiated sin th March  2018  and  till  June  2018,  about  2045  MDR  TB  patients  have  been  initiated  o shorter regimen treatment.
- In 2018, Bedaquiline availabil ity has been scaled up for treatment of drug resistant TB treatment and during 1 st January to 30 th June, 2018 , about 510 patients have been initiated on Bedaquiline based treatment regimen across the country.
- 226 District level drug resistant TB Centre hav e been established so far.
- NIKSHAY Poshan Yojana for providing financial assistance for nutrition support at rate of Rs. 500/ -per month for the duration of TB treatment has been initiated since st April 2018.
- E - Health advances: The case based web based TB notification system (NIKSHAY) has been enhanced with digital advancements.

## Private Sector Engagement

- o Memorandum of Understanding (MoU ) has been signed with the Indian Medical Association  (IMA)  for  wide  dissemination  of  services  for  TB  patients  throu RNTCP. Under this MoU, private providers will be sensitized in 1000 out of 17 IMA branches in the country.
- o Public  private  support  agency  interventions  have  been  initiated  in  45  large cities and 348 districts where in, intensified efforts for notification from private sector, use of rapid molecular tests and Govt. provided drugs is accelerated.

## (d): The other measures taken by the Government to eradicate TB are:

- Community  Engagement  and  Multi - stakeholder  efforts: For  patient  centric  and community  led  response  to  TB,  National  TB  Forum  has  been  established  to  engage community. Similarly, State and District level forums are being estab lished to create a network of TB Champions.
- Advocacy  Communication  and  Social  Mobilisation  (ACSM): Intensified  Media Campaign using all media platforms such as Audio - visual, Print, Digital, Outdoor and Social media for raising awareness, increasing utiliz ation of services, reducing stigma & discrimination, increasing private sector participation, etc.

## Annexure

| Revised National TB Control Programme State wise Releases & Expenditure (Cash & Kind)   | Revised National TB Control Programme State wise Releases & Expenditure (Cash & Kind)   | Revised National TB Control Programme State wise Releases & Expenditure (Cash & Kind)   | Revised National TB Control Programme State wise Releases & Expenditure (Cash & Kind)   | Revised National TB Control Programme State wise Releases & Expenditure (Cash & Kind)   |
|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|-----------------------------------------------------------------------------------------|
| Sl. No.                                                                                 |                                                                                         | Allocation 2017-18 (Rs. In lakhs)                                                       | Allocation 2017-18 (Rs. In lakhs)                                                       | Allocation 2017-18 (Rs. In lakhs)                                                       |
|                                                                                         | Name of the State / UT                                                                  | Cash                                                                                    | Commodity                                                                               | Total                                                                                   |
| 1                                                                                       | Andhra Pradesh                                                                          | 2099.65                                                                                 | 414.48                                                                                  | 2514.13                                                                                 |
| 2                                                                                       | Andaman & Nicobar                                                                       | 96.48                                                                                   | 3.54                                                                                    | 100.02                                                                                  |
| 3                                                                                       | Arunachal Pradesh                                                                       | 462.58                                                                                  | 70.11                                                                                   | 532.69                                                                                  |
| 4                                                                                       | Assam                                                                                   | 1270.49                                                                                 | 1415.90                                                                                 | 2686.39                                                                                 |
| 5                                                                                       | Bihar                                                                                   | 3275.28                                                                                 | 139.39                                                                                  | 3414.67                                                                                 |
| 6                                                                                       | Chandigarh                                                                              | 161.40                                                                                  | 10.00                                                                                   | 171.40                                                                                  |
| 7                                                                                       | Chattisgarh                                                                             | 1384.21                                                                                 | 219.66                                                                                  | 1603.87                                                                                 |
| 8                                                                                       | D & N Haveli                                                                            | 75.77                                                                                   | 3.43                                                                                    | 79.20                                                                                   |
| 9                                                                                       | Daman & Diu                                                                             | 48.10                                                                                   | 2.43                                                                                    | 50.53                                                                                   |
| 10                                                                                      | Delhi                                                                                   | 2858.20                                                                                 | 110.23                                                                                  | 2968.43                                                                                 |
| 11                                                                                      | Goa                                                                                     | 134.57                                                                                  | 12.21                                                                                   | 146.78                                                                                  |
| 12                                                                                      | Gujarat                                                                                 | 2565.34                                                                                 | 1167.13                                                                                 | 3732.47                                                                                 |
| 13                                                                                      | Haryana                                                                                 | 1163.39                                                                                 | 217.47                                                                                  | 1380.86                                                                                 |
| 14                                                                                      | Himachal Pradesh                                                                        | 674.66                                                                                  | 274.67                                                                                  | 949.33                                                                                  |
| 15                                                                                      | Jammu & Kashmir                                                                         | 1084.03                                                                                 | 108.06                                                                                  | 1192.09                                                                                 |
| 16                                                                                      | Jharkhand                                                                               | 1674.09                                                                                 | 67.98                                                                                   | 1742.07                                                                                 |
| 17                                                                                      | Karnataka                                                                               | 3010.92                                                                                 | 627.87                                                                                  | 3638.79                                                                                 |
| 18                                                                                      | Kerala                                                                                  | 1430.53                                                                                 | 169.91                                                                                  | 1600.44                                                                                 |
| 19                                                                                      | Lakshadweep                                                                             | 41.25                                                                                   | 0.60                                                                                    | 41.85                                                                                   |
| 20                                                                                      | Madhya Pradesh                                                                          | 3125.94                                                                                 | 188.87                                                                                  | 3314.81                                                                                 |
| 21                                                                                      | Maharashtra                                                                             | 7285.22                                                                                 | 1929.90                                                                                 | 9215.12                                                                                 |
| 22                                                                                      | Manipur                                                                                 | 386.04                                                                                  | 134.90                                                                                  | 520.94                                                                                  |
| 23                                                                                      | Meghalaya                                                                               | 284.20                                                                                  | 149.60                                                                                  | 433.80                                                                                  |
| 24                                                                                      | Mizoram                                                                                 | 325.06                                                                                  | 54.19                                                                                   | 379.25                                                                                  |
| 25                                                                                      | Nagaland                                                                                | 356.16                                                                                  | 95.97                                                                                   | 452.13                                                                                  |
| 26                                                                                      | Orissa                                                                                  | 1921.68                                                                                 | 355.30                                                                                  | 2276.98                                                                                 |
| 27                                                                                      | Puducherry                                                                              | 216.80                                                                                  | 8.77                                                                                    | 225.57                                                                                  |
| 28                                                                                      | Punjab                                                                                  | 1220.42                                                                                 | 234.71                                                                                  | 1455.13                                                                                 |
| 29                                                                                      | Rajasthan                                                                               | 2366.75                                                                                 | 805.31                                                                                  | 3172.06                                                                                 |
| 30                                                                                      | Sikkim                                                                                  | 189.00                                                                                  | 272.48                                                                                  | 461.48                                                                                  |
| 31                                                                                      | Tamilnadu                                                                               | 2772.85                                                                                 | 1047.49                                                                                 | 3820.34                                                                                 |
| 32                                                                                      | Tripura                                                                                 | 226.47                                                                                  | 57.85                                                                                   | 284.32                                                                                  |
| 33                                                                                      | Uttar Pradesh                                                                           | 7477.16                                                                                 | 955.26                                                                                  | 8432.42                                                                                 |
| 34                                                                                      | Uttrakhand                                                                              | 660.43                                                                                  | 86.50                                                                                   | 746.93                                                                                  |
| 35                                                                                      | West Bengal                                                                             | 3321.32                                                                                 | 338.23                                                                                  | 3659.55                                                                                 |
| 36                                                                                      | Telangana                                                                               | 1500.56                                                                                 | 404.60                                                                                  | 1905.16                                                                                 |
| Total                                                                                   | Total                                                                                   | 57147.00                                                                                | 12155.00                                                                                | 69302.00                                                                                |