Turmeric Man of Himachal Pradesh

Tuberculosis (TB) remains one of the most serious public health challenges in India, despite various initiatives aimed at its elimination. Himachal Pradesh, a state with diverse geography and rural population, has been actively working to tackle this infectious disease. The State Tuberculosis Cell (STC) recently reported that 12,835 TB patients are currently under treatment, with Kangra district leading the numbers with 2,322 cases. The state’s multi-sectoral approach and community-driven initiatives have been instrumental in curbing TB, yet significant challenges remain.

Understanding Tuberculosis (TB)

TB is a bacterial infectious disease caused by Mycobacterium tuberculosis, primarily affecting the lungs but capable of spreading to other parts of the body if left untreated. TB is spread through airborne droplets when an infected person coughs, sneezes, or even talks. There are different types of TB that individuals can develop:

1. Pulmonary TB: This is the most common and contagious form of TB, affecting the lungs. It spreads through the air when an infected person releases droplets containing the bacteria. People may carry the bacteria without developing symptoms if their immune system contains the infection.
2. Latent TB: In some cases, the immune system doesn’t completely eliminate the bacteria but keeps it dormant, leading to latent TB. Although people with latent TB don’t show symptoms and aren’t contagious, the bacteria can reactivate when the immune system weakens.
3. Active TB: When the immune system cannot control the infection, it spreads within the lungs or to other parts of the body, resulting in symptoms like persistent cough, chest pain, fever, night sweats, and weight loss.

TB in Himachal Pradesh: Current Scenario

At a seminar held by the State Tuberculosis Cell (STC) in Shimla, data was shared that highlighted the current state of TB in Himachal Pradesh. Kangra district reported the highest number of TB cases (2,322), followed by Mandi (2,055), Solan (1,416), and Shimla (1,405). On the other hand, the remote district of Lahaul and Spiti reported just 52 cases.

In 2022, the state recorded 16,072 TB patients, with 13,935 successfully treated. By 2023, the number of TB cases had reduced to 15,638, with 10,223 patients fully recovering. As of September 2024, 723 out of the 3,615 gram panchayats in the state were declared TB-free, a significant achievement considering the challenges of rural outreach.

Government Initiatives in Himachal Pradesh

The state’s effort to eliminate TB aligns with the National Health Mission (NHM) and the National Tuberculosis Elimination Programme (NTEP). Key initiatives include:

1. Active Case Finding (ACF): The state has been implementing a weekly Sunday Active Case Finding campaign, in which ASHA workers screen high-risk populations for TB symptoms. In 2023, over 23 lakh individuals were screened, leading to 219 new TB diagnoses.
2. Free Diagnosis and Treatment: Himachal Pradesh ensures free diagnosis and treatment services to TB patients through public health facilities. This initiative is part of the larger framework of NTEP.
3. Private Sector Engagement: The state involves private healthcare providers in TB management to improve case detection and treatment adherence.
4. Community Involvement: Initiatives such as the Chemist Engagement Programme and Indoor Ward Screening help detect presumptive cases. Additionally, the state works with self-help groups (SHGs), youth organizations, and medical colleges to raise awareness and tackle the stigma associated with TB.

According to Priyanka Verma, Mission Director of the NHM in Himachal Pradesh, the state’s testing rate for TB is four times higher than the national average. This proactive approach has significantly contributed to the identification of new cases and the prevention of the disease’s spread.

The Role of Community and Challenges

Dr. Ravinder Kumar, State Programme Officer of NTEP, emphasized that community partnerships have been central to the state’s progress in fighting TB. Collaborations with local chemist associations, SHGs, Gram Sabha leaders, and media outlets have helped raise awareness about the disease and promote health-seeking behavior. However, challenges remain, especially in remote regions where myths, stigma, and inadequate health infrastructure still pose barriers to effective TB control.

The state government’s involvement of 27 departments in a multi-sectoral engagement approach has been instrumental in increasing community outreach, ensuring that individuals receive proper treatment and support.

TB in India: A Broader Perspective

India remains the largest contributor to TB cases worldwide, accounting for 28% of the global burden. According to the Global TB Report 2022 by the World Health Organization (WHO), India reported a TB incidence of 210 per 100,000 population in 2021, a decline from 256 per 100,000 in 2015. Despite this, case reporting has not reached pre-pandemic levels.

Through the Ni-kshay portal, which tracks real-time TB case reporting, 21.3 lakh TB cases were detected in 2021, a significant rise from 18.05 lakh cases in 2020. India has also seen a decrease in drug-resistant TB cases, with 1.19 lakh cases in 2021 compared to 1.49 lakh in 2015.

National TB Elimination Programme (NTEP)

The Government of India has committed to eliminating TB by 2025, a goal that requires strong partnerships at both national and state levels. The National Strategic Plan for TB Elimination, launched in 2017, guides the country’s efforts. Some of the key components include:

• Active Case Finding (ACF): Reaching out to high-risk populations and identifying new TB cases through screening campaigns.
• Private Sector Engagement: Collaborating with private healthcare providers to increase TB case reporting and ensure treatment adherence.
• Community Awareness Campaigns: Educating the public about TB symptoms and the importance of early diagnosis and treatment adherence.
• Multi-Sectoral Engagement: Engaging multiple government departments and stakeholders in the TB elimination effort.

Conclusion

Himachal Pradesh’s fight against tuberculosis is a testament to the power of community involvement, government commitment, and innovative health initiatives. Despite challenges, the state has made remarkable progress, reducing the number of active TB cases and increasing the number of TB-free gram panchayats. With continued efforts under the National Health Mission and the National Tuberculosis Elimination Programme, Himachal Pradesh is on the right path to achieving its goal of becoming TB-free by 2025.

However, eliminating TB requires sustained efforts to raise awareness, dispel myths, and provide timely treatment, particularly in remote areas where healthcare access is limited. By continuing to strengthen its health systems and involving communities in the fight against TB, Himachal Pradesh can set an example for the rest of the country.