The government must establish a department of public health soon -Sujatha Rao
It will give the failing discipline the priority, energy and momentum it requires
To eliminate tuberculosis by 2025, a decision to integrate the two vertically implemented programmes — tuberculosis with HIV/AIDS — was taken in March, and an expert committee was constituted to provide the operational strategies for it. The argument for this integration is unquestionable. When HIV/AIDS claimed 30 million lives in the 1990s, it was declared a global emergency and several countries swung into action to contain the epidemic.
India, with the third highest number of HIV infections, established the National AIDS Control Organisation (NACO) in 1992 under the ministry of health and family welfare. NACO, however, had operational freedom. This enabled it to innovate and work with 29 developmental partners, people with HIV and communities most vulnerable to infection, state governments, media, judiciary, medical colleges, research institutions and civil society. This led to a 67% decline in HIV incidence in India, one of the highest rate of decline in the world.
Since 2014, however, the march has been halted: Shifts in strategy and reduced funding have weakened NACO, resulting in HIV incidence rising in some states.
With the introduction of the Directly Observed Treatment Shortcourse (DOTS) to treat TB in 1995, the World Health Organization (WHO) in India wanted India’s TB programme to be provided a NACO-like instrumentality. The ministry strongly resisted it as the critical nature of the disease made it vital for it to be under the direct supervision of the Directorate General of Health Services for speedy implementation. The programme was scaled up, but lost its momentum with its integration with the National Rural Health Mission in 2005, which accorded a higher priority to reproductive and child health. Infectious disease-control programmes, including TB, fell in importance, resulting in the annual TB incidence remaining stagnant at 2.8 million, with 0.43 million deaths. Worse, projections indicate that by 2022, India will account for 42% of the world’s multidrug-resistant (MDR) TB, up from 16% today.
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