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Abstract
BackgroundThe key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. Social infrastructure development generates social capital and addresses the crucial social determinants of TB, thereby improving program performance. Recently, there has been renewed interest in the concept of social infrastructure development for TB control in developing countries. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. Further, it explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings.MethodsA wide range of published Government records pertaining to social development parameters and TB program surveillance, between 2001 and 2011 in Delhi, were studied. Social infrastructure development parameters like human development index along with other indicators reflecting patient profile and habitation in urban settings were selected as social determinants of TB. These include adult literacy rates, per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units. The impact of the Revised National Tuberculosis Control Program on TB incidence was assessed as an annual decline in new TB cases notified under the program. Univariate linear regression was employed to examine the interrelationship between social development parameters and TB program outcomes.ResultsThe decade saw a significant growth in most of the social development parameters in the State. TB program performance showed 46% increment in lives saved among all types of TB cases per 100,000 population. The 7% reduction in new TB case notifications from the year 2001 to 2011, translates to a logarithmic decline of 5.4 new TB cases per 100,000 population. Except per capita income, literacy, and net migration rates, other social determinants showed significant correlation with decline in new TB cases per 100,000 population.ConclusionsSocial infrastructure development leads to social capital generation which engenders positive growth in TB program outcomes. Strategies which promote social infrastructure development should find adequate weightage in the overall policy framework for urban TB control in developing countries.
Highlights
The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population
Measurement of new TB cases is based on the World Health Organization (WHO) policy package for calculating rates of TB incidence, which states that in countries where TB programs have focused on a systematic approach for assessing the quality and coverage of TB surveillance data, the data from program records is ‘certified’ as a direct measure of TB incidence and is a close proxy for TB incidence in the area [16]
In the study, social determinants which pose as indirect indicators of social capital, such as human development index (HDI), along with indicators reflecting patient profile and habitation in slums, such as adult literacy rates (>7 years age), per capita income, net migration rates, percentage growth in slum population, and percentage of urban population living in one-room dwelling units have been chosen as a measure of social development
Summary
The key to universal coverage in tuberculosis (TB) management lies in community participation and empowerment of the population. This study aims to revive this concept and highlight the fact that documentation on ways to operationalize urban TB control is required from a holistic development perspective. It explains how development of social infrastructure impacts health and development outcomes, especially with respect to TB in urban settings. There have been important advances in the global fight against tuberculosis (TB) and towards achievement of the Millennium Development Goals. In order to accelerate economic and social growth and reduce the global burden of TB, it is essential to fight TB and poverty together. As TB is a medical condition with significant social dimensions, it is essential that while addressing health equity, any systematic framework for assessment of health care must look beyond medical excellence as good health means to reduce suffering but to expand a person’s life in order to be able to do what s/he wishes to achieve
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