Abstract
IntroductionTuberculosis remains a major public health problem in India with the country accounting for one-fifth or 21% of all tuberculosis cases reported globally. The purpose of the study was to obtain an understanding on pro-poor initiatives within the framework of tuberculosis control programme in India and to identify mechanisms to improve the uptake and access to TB services among the poor.MethodologyA national level workshop was held with participation from all relevant stakeholder groups. This study conducted during the stakeholder workshop adopted participatory research methods. The data was elicited through consultative and collegiate processes. The research study also factored information from primary and secondary sources that included literature review examining poverty headcount ratios and below poverty line population in the country; and quasi-profiling assessments to identify poor, backward and tribal districts as defined by the TB programme in India.ResultsResults revealed that current pro-poor initiatives in TB control included collaboration with private providers and engaging community to improve access among the poor to TB diagnostic and treatment services. The participants identified gaps in existing pro-poor strategies that related to implementation of advocacy, communication and social mobilisation; decentralisation of DOT; and incentives for the poor through the available schemes for public-private partnerships and provided key recommendations for action. Synergies between TB control programme and centrally sponsored social welfare schemes and state specific social welfare programmes aimed at benefitting the poor were unclear.ConclusionFurther in-depth analysis and systems/policy/operations research exploring pro-poor initiatives, in particular examining service delivery synergies between existing poverty alleviation schemes and TB control programme is essential. The understanding, reflection and knowledge of the key stakeholders during this participatory workshop provides recommendations for action, further planning and research on pro-poor TB centric interventions in the country.
Highlights
Tuberculosis remains a major public health problem in India with the country accounting for onefifth or 21% of all tuberculosis cases reported globally
Expanding tuberculosis control in India has led to a total health benefit of 29.2 million disability adjusted life years (DALYs) and generating a return of US$ 115 for every 1 US$ spent [14]
Referring to the study by Goodchild et al (2011), the Revised National TB Control Programme (RNTCP) programme manager highlighted that an effective TB control programme was already a positive step towards reducing economic ‘health shocks’ and poverty alleviation
Summary
Tuberculosis remains a major public health problem in India with the country accounting for onefifth or 21% of all tuberculosis cases reported globally. Of the 22 TB high-burden countries accounting for 81% of the global TB burden, 10 countries are categorised under the ‘low income category’ (GNI < US $ 995), and 9 countries under lower middle income category (GNI US $ 9963,945), as per World Bank benchmarks for income group classification [1,4] Within these already poor countries, there are significant disparities compounded by large populations that are densely distributed and with restricted access to basic health services. That deprivation of health is the second most significant contributor to overall poverty in India after living standard provides ample indication of the prevailing poverty-health co-relation [7] It is often the poor and socially excluded groups that are disproportionately exposed to ill-health and are unlikely to receive care
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