Engage the private sector in the battle against TB

Together, both the government and the private sector can end this easily detectable and curable disease by 2025

The World Health Organisation (WHO) released its annual Global TB Report this month. Of the estimated 10.6 million people who developed tuberculosis, only 7.5 million people were diagnosed and notified to TB programmes globally – leaving an estimated 3.1 million cases possibly undetected and unreported last year. The Achilles Heel in global TB control remains diagnosis. After all, as colleagues in a Nature article said, “If we cannot find TB, we cannot treat TB. And if we cannot treat TB, we cannot end TB.”

The private sector can be an equal partner in the effort to eliminate TB. (AFP)

The National TB Prevalence Survey conducted by the Indian Council of Medical Research found that nearly 50% of people with TB symptoms seek care in the private sector, with the figure reaching as high as 70% in some states. It is encouraging, therefore, that India’s National TB Elimination Programme has taken cognisance of the importance of engaging with the private health care sector. A comprehensive strategic framework with legal measures, incentives, and partnerships has been instrumental in increasing notifications from the private sector. In 2022, 720,000 notifications came from the private sector which constituted only 30% of all cases reported to the programme. There is still a long way to go.

During the pandemic, when the private sector was co-opted as a public resource to diagnose, treat and prevent the spread of SARS-CoV2, we saw what a boost it provided to the country’s overall response. As we look to reach the “last mile” and close the gap in incidence and case reporting, we must harness the largely untapped potential of India’s private laboratory network to expand the country’s diagnostic capacity.

The National Accreditation Board for Testing and Calibration Laboratories (NABL) has played a central role in ensuring quality in medical testing laboratories across the country; by the end of 2022, NABL accredited 2,300 private laboratories. The accreditation process must be made more accessible to ensure the country expands the number of private laboratories that can offer quality diagnosis. To that end, the procedures for accreditation and certification can be optimised by removing unnecessary barriers and keeping essential quality assurance components. The focus must also be on creating a supportive ecosystem to ensure microbiologists can navigate the accreditation process efficiently and effectively. For instance, the stringent space requirements for accreditation make it extremely challenging for certain laboratories to receive NABL accreditation. While striking a balance between safety and practicality, these norms can be adjusted to accommodate the operational constraints often faced by private labs.

To ensure quality control, external quality assurance programmes which are used to periodically assess the quality of a lab’s performance, too, can be made more accessible and tailored to the specific needs of private labs. Encouraging modern information management systems (aligned with ISO standards) can also help facilitate better record-keeping and compliance with accreditation requirements. Streamlined procurement processes and guidance on standardised kits and consumables are essential. Labs also need much more assistance (from government programmes or research institutes) in accessing quality control strains for identifying and testing drug resistance to maintain the accuracy of results.

Further, we must consider financial incentives, grants and/or subsidies to alleviate the financial burden associated with acquiring essential equipment and to make quality TB diagnostics accessible. In an immediate step — till the time India steps up its domestic production — the government must reduce the steep import duties on essential cutting-edge testing equipment and consumables to ensure affordable procurement by private labs to make TB testing much more affordable.

The private sector can be an equal partner in the effort to eliminate TB. We have seen that partnership models such as the Initiative for Promoting Affordable and Quality TB Tests (IPAQT), a network that brought together over 300 private laboratories to provide the latest WHO-recommended TB diagnostic tests, lowered TB testing prices by over 50%. A significant increase in volume (through pooled procurement) helped cut costs and make modern diagnostics accessible and affordable.

We stand at a pivotal moment in our country’s battle against TB. The country’s Covid-19 response showcased the transformative power of strategic collaboration between the public and private sectors against a common enemy. Together, both sectors can end this easily detectable and curable disease by 2025.

Navin Dang is a senior medical microbiologist and founder and chairman of Dr Dangs Lab. The views expressed are personal