Anti-TB meds stock outs, Nanded deaths highlight missing links

If the containment of the Nipah virus was an example of alert health officials, we have enough examples of the other extreme


Even though the WHO chief declared that COVID was no longer a pandemic on May 5 this year, SARS-CoV-2 continues to cast a long shadow. And only rightly so. The Indian SARS-CoV-2 Genomics Consortium (INSACOG), a consortium of 54 laboratories, continues to monitor the genomic variations in the virus. Unfortunately, SARS-CoV-2 takes away attention and resources from other bugs that continue to threaten our health.

For instance, the Nipah virus continues to lurk. Timely action by Kerala’s health authorities restricted the most recent flare up in September to two deaths and six identified cases, out of the 387 samples screened. The stats are chilling: this was the third Nipah virus outbreak in Kerala’s Kozhikode district, the fourth outbreak in the state since 2018 and the sixth outbreak in India.

The chinks in our public health armour continue to be exposed. If the containment of the Nipah virus was an example of alert health officials, we have enough examples of the other extreme.

A sudden spike in deaths in Maharashtra’s Shankarrao Chavan government hospital in Nanded district, (35 patients died within 48 hours, including 12 infants in a 24 hour span) raised the red alert once again.

The Nanded facility is reportedly the only health care centre in a 70-80 km radius, so health authorities initially blamed the increase in deaths on increased footfall and not lack of staff, infrastructure of medication. News reports quote parents alleging that 3-4 infants were sharing a single incubator in the NICU, indicating a shortage of incubators.

While an inquiry is under way, this tragic news is a replay of previous occasions, not just in Maharashtra but in other states as well.

Besides healthcare infrastructure, infectious diseases like TB, malaria, and dengue need to be constantly tracked. As per the WHO Global Tuberculosis Report, 2022 India has 28 per cent of the global TB burden and 36 per cent of TB-related deaths. TB is thus a ticking timebomb with a very short lighted fuse. No wonder Prime Minister Narendra Modi wants to end TB in India by 2025, five years before the global deadline.

Unfortunately, recurring shortages in the availability of anti-TB medicines could roll back years of progress. Since June, Survivors Against TB (SATB) have highlighted severe shortages of essential anti-TB medications in government hospitals and private pharmacies in Mumbai, Uttar Pradesh, and other states. These include linezolid, clofazimine, and cycloserine, meant for multi drug resistant TB cases.

However, the government seems to be in denial. When the health ministry issued a clarification, titled ‘Myths vs facts’, claiming that reports claiming shortage of anti-TB medicines are ‘False, Motivated and Misleading’, SATB replied with more questions.

The biggest missing link in India’s public health is the lack of doctors and other health care staff willing to serve in government health facilities beyond the urban areas. A recent study titled, The pharmacy as a primary care provider, published recently in the Frontiers of Public Health, posits that one way to fix this is to train pharmacists, who are ‘already more than just mechanical dispensers of medicines in the South Asian context.’

The authors conclude that their analysis ‘provides support for the view that pharmacies have many of the inherent characteristics needed to become an effective primary care channel and already play an important role in providing access to health information and care.’

The article suggests that we need to ‘explore how protocols and training could be used to both improve the quality of clinical services provided by pharmacies and even encourage them to, as it were, step up to this role.’ Given the perceived threat from online/e-pharmacies, and the increasing acceptance of telemedicine among doctors, this could be the right time to get pharmacists on board.

Similarly, community health workers (CHWs) are another underutilised resource, suggests a separate article in the same publication. Titled ‘Evolution of community health workers: The fourth stage’, the authors suggest that there are potentially four stages in the evolution of the CHW – the health messenger, the physician extender, the focused provider, and the comprehensive provider.

Their analysis of CHW-centric programmes across the world threw up six programmes (two global and four in India) that they felt had progressed to the fourth stage. This stage is characterised by a shift in control away from the general practitioner to the CHW; and secondly, comprehensive care, which differentiates it from the other three stages of the evolution of the CHWs.

More data will be required to translate these observations into policy changes but these seem to be rational steps in the right direction.

Technology does hold some solutions to infrastructure and human resource gaps. The cover story in the October edition of Express Healthcare focuses on the radiology and imaging revolution in India’s TB battle and explores how imaging technologies, combined with new age tools like AI and ML, can aid screening and early diagnosis.

However, be it getting TB drugs to patients or harnessing innovative imaging solutions, collaborations between the public and private sectors will be required to scale up the success of such interventions.



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