Factors influencing the perceived priority of tuberculosis in India

Abstract

The objective of this study was to understand the priority attached to tuberculosis in India by the major stakeholders in the National Tuberculosis Programme, to explore the underlying factors, and to suggest illustrative steps to enhance the effectiveness of the programme delivery. Major stakeholders were broadly grouped into three categories: the programme providers (the entire government system involved in the design and delivery of the programme, starting with the health ministry at the central government to the health workers at the field level), the programme recipients (patients as well as community at large), and the tuberculosis watchdogs (including the not-for-profit organisations such as the Tuberculosis Association of India and Foundation for Research in Community Health, as well as the media). The perceived priorities of stakeholders were explored through a combination of approaches. Methodology included discussions with programme functionaries form the apex level to the grassroots level, structured and semi-structured interviews covering all the stakeholders, questionnaire surveys of priorities of government doctors and health workers, and the experiences of tuberculosis patients, perusal of relevant documents, research reports, and newspaper reports, etc. Our analysis showed an overall low priority for tuberculosis. It manifested itself in a variety of ways: from low plan allocations for tuberculosis among the communicable diseases, and frequent change of the senior-most functionary in the tuberculosis division at the central level, to a relatively-low importance attached by the government doctors, and competing priorities and pressures for the health workers at the field level. Patients experiences reflected the fallout in terms of indifferent programme delivery. Perusal of the electronic and print media indicated that there was tremendous scope to use this powerful tool for awareness-building about tuberculosis among the larger community in general and for giving specific inputs and message of hope to people suffering from tuberculosis in particular. Our report concludes with suggestions and illustrative steps for enhancing the effectiveness of the Revised National Tuberculosis Programme in India.