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In a project funded by the Bill & Melinda Gates Foundation and implemented by international NGO PATH, patients with cough living in slums or poor localities will get the voucher to gently prod them to undergo an X-ray .The programme, called the Private Provider Interface Agency (PPIA), will focus on the 12 wards identified as highrisk for TB and cover almost 9 million people.
"During our interactions with doctors, we found they are reluctant to mention TB to patients on their first visit and choose instead to write out antibiotics for their persistent cough," said Dr Arun Bamne, who is a consultant with the BMC for the TB control programme. The patient feels better because the antibiotics check the tuberculosis for some time, but the problem invariably returns, at times in a potent form.
The PPIA programme will try to break this cycle, said PATH project director Dr Shibu Vijayan. "The vouchers, which are being used in the Indian public health sphere for the first time, will act as an incentive," said Dr Vijayan, adding that the same programme is being implemented in Mehsana, Gujarat, and in Patna, Bihar. In Mumbai, the aim is to draw 20,000 more patients into the programme by 2017.
The city received the first booster dose for TB control in 2012 when reports of totally drug-resistant TB cases cropped up for the first time.The Union government immediately released special funds, granted hi-tech infrastructure and drew up a special plan for Mumbai. As a result, detection rates soared, with the number of drug-resistant cases climbing to almost 3,700 in the last two years.
"Despite the best effort and services, the public health system at best draws 50-60% of the targeted population. There is a huge population that prefers the private sector," said BMC's TB officer Dr Minni Khetrapal. As the private sector doesn't follow standard protocols, it is feared not all patients get equal or right treatment."Using programmes such as the PPIA, we want to be able to cover 100% of the population," added the doctor.
To start with, the pro gramme has identified 40 small and medium hospitals where the voucher can be used. "Patients who go to informal doctors with complaint of cough will be sent for a free X-ray at the nearest hub hospital we have identified," said Dr Vijayan. If the X-ray shows worrisome signs, the patient will be sent for a subsidized GeneXpert scan, costing barely Rs 500 as against the Rs 1,500 in other labs.
"If the GeneXpert test shows the patient has normal TB, he can use the voucher to buy free medicines for up to six months from a chemist," said Dr Bamne. If the GeneXpert shows the patient has drugresistant TB, he will be inducted into the BMC-run free treatment programme. The BMC gets medicines, costing Rs 2-5 lakh for each patient, from the Revised National Tuberculosis Control Programme.
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