For private circulation only Newsletter Vol. 6 No. 1 Budget Session Issue February-April 2017 Dear Friends, At a glance: On behalf of the IMPF, we are pleased to release the lThe problem of tuberculosis in India IMPF Newsletter, Budget Session 2017 issue. The IMPF lMental Healthcare for Social Integration: A Hidden Emergency Newsletter is circulated widely amongst Members of lEradicating Leprosy and Its Social Parliament and other stakeholders. We hereby Stigma acknowledge all the responses and suggestions that we lEnding HIV/AIDS in 2030 have received on alarming issues of public health in India. lBringing Public Health to Centre Stage We take this opportunity to welcome the new National lNews Boxes Health Policy 2017 (NHP 2017), which was approved by the Union Cabinet on 15 March, 2017. The new NHP offers renewed measures to address much known deficiencies of public health sector in India. It is set to increase the public spending to 2.5 percent of GDP by 2025, from the current 1.15%. The NHP 2017 also proposes free diagnostics, free drugs, and free emergency and essential health services in all public hospitals, which will accelerate access to free and affordable medicine and treatment for patients. In this issue, we highlight the issues of eradicating Leprosy, Tuberculosis, issues related addressing NCDs and HIV/AIDS. We express our sincere thanks to all the contributors who have made this newsletter more informative. We look forward to working with you in the future as we continue to carry forward our responsibilities in more productive way. Dr. Boora Narsaiah Goud MP Dr. Kirit Premjibhai Solanki MP Dr. Vikas Mahatme MP Chairperson Co-Convenors Patron IMPF Members Jagat Prakash Nadda Hon. Union Minister, MoHFW Dr. Harsh Vardhan Dr. Subhash Ramrao Bhamre Dr. Mahesh Sharma Dr. V. Maitreyan Dr. Shrikant Eknath Shinde Dr. Yashwant Singh Editorial Board Dr. Ravindra Babu Pandula Dr. Heena Vijaykumar Gavit Dr. Kakoli Ghosh Dastidar Dr. Yashwant Singh Dr. Anbumani Ramadoss Dr. Pritam Munde Dr. Mamtaz Sanghamita Dr. Heena Vijayakumar Gavit Dr. C.P Thakur Dr. Kulamani Samal Dr. Ratna De (Nag) Dr. Mamtaz Sanghamita Dr. Naramalli Sivaprasad Dr. Dharam Vira Gandhi Dr. Uma Saren Dr. Sanjay Jaiswal Dr. Manoj Rajoria Dr. Mriganka Mahato Editor Dr. Banshilal Mahto Dr. Jayakumar Jayavardhan Dr. Bhushan Lal Jangde Vinod Bhanu Dr. Kirit Premjibhai Solanki Dr. K. Kamraaj Dr. R. Lakshmanan Dr. Bharati Dirubhai Shiyal Dr. K. Gopal Dr. K. V. P. Ramachandra Rao Dr. K. C. Patel Dr. Ponnusamy Venugopal Dr. Vikas Mahatme Editorial Inputs Dr. Jitendra Singh Dr. Boora Narsaiah Goud Cara Aquilina Aditi Shastri IMPF Newsletter February-April 2017 The problem of tuberculosis in India Tuberculosis (TB) is a treatable disease yet in treatment plan on receiving a call. SMS technology 2015 it killed 1.8mn people globally, and has killed can be used to contact the patient or the healthcare more people than any other infectious disease in provider regarding an individual’s treatment. history (WHO TB Factsheet, 2016). India carries an Whilst such a system is laudable, Jose Luis Castro undue burden in respect of tuberculosis, (Executive Director of the International Union contributing to a quarter of cases worldwide. As a Against Tuberculosis and Lung Disease), noted that signatory of the WHO End TB strategy, India must the majority of TB medication was ‘invented before ensure that the elimination of TB. The Revised astronauts walked on the moon’. Research and National TB Control Programme (RNTCP) development is imperative to create new treatments implements mechanisms to achieve this goal. that are more efficient and reduce the risk of MDR- TB. Tuberculosis is an infectious disease caused by the bacteria ‘mycobacterium tuberculosis’. It is Collaboration and commitment between spread between persons as a result of one coughing, stakeholders including the government, health sneezing or spitting and another ingesting the providers, NGOs and individual citizens is bacteria. Long term exposure to the bacteria or a imperative to eliminate TB. The India TB Caucus, weakened immune system can result in infection. launched on the 8 March 2017 is a commendable For example, those suffering from HIV/AIDS and advance. This focus group consists of diabetes are at risk. ‘Active’ TB means the patient is parliamentarians who are committed to suffering from TB and should seek medical attention. championing the TB cause. They seek to raise Whilst ‘latent’ TB means that inactive TB bacteria are a w a r e n e s s n o t o n l y a m o n g s t f e l l o w in one’s body, this is carried by roughly 1/3 of the parliamentarians, but also within their respective global population. constituencies thereby increasing resources and capital to address TB. Supported by The Global TB Diagnosing TB is difficult and expensive. Caucus, there is the potential to bring TB narrative to Sputum collection testing is a common, inexpensive the forefront in India, with the result of eventual method used in India. However, it lacks sensitivity elimination. The mobilisation of such stakeholders is and fails to detect TB in children. The ‘Genexpert’ important and indicates a movement in the correct technology is a welcome development. It uses direction but the pressure must not cease there. sputum samples and provides results within 2 hours. Such equipment is of limited availability and access The problem of TB in India is complex, largely is determined according to geographical location. underrepresented and misunderstood. The The availability of such technology must be elimination of TB will be an arduous task requiring increased to achieve a national standard of care. an accelerated effort and sustained commitment from a variety of stakeholders over a sustained The Directly Observed Treatment Short Course period. The current focus and rate of decline in (DOTS) strategy is not without flaws. TB treatment relation to TB requires acceleration if the 2035 target requires daily medication for 6 months. Completing is to be achieved. Holistic efforts encompassing the full course is imperative to prevent Multi-drug research and development, awareness campaigns resistant TB (MDR-TB), the treatment of which is and improved access to healthcare facilities are invasive and arduous. The ‘pill-in-hand’ tool has required to eliminate TB in India. been developed to monitor and ensure patients’ adherence to treatment. Patients must free-phone the - Dr. Boora Narsaiah Goud number printed inside each pill casing. A database is Member of Parliament updated noting that the patient is adhering to the 2 IMPF Newsletter February-April 2017 Mental Healthcare for Social Integration: A Hidden Emergency Mental health discourse has come a long way. psychiatric care. Such a response has resulted in a The institution-wide ostrich approach taken significant socio-economic cost of bearing a mental previously, has progressed to the point where these disorder. The impact on those suffering from an same institutions encompass and understand mental illness and the importance and necessity of disorders as a health issue. This is increasingly psychotherapy and counselling is consistently important, as WHO estimate that 20% of India’s overlooked. population will suffer from some form of mental illness by the year 2020. However, one must not over By addressing mental illness from a holistic estimate the progress made thus far, serious perspective and by empowering mentally ill hindrances to appropriate care are in existence, and persons, the Bill seeks to remove the stigma attached hence the level of care afforded to patients is still to mental illness. It seeks to secure equal treatment somewhat inadequate. for both with mental and physical illness. As per NIMHANS, Bengaluru there are more Irrespective of how progressive the new bill is, it than 7 crore mentally ill people in India and less than fails to go far enough in the direction of reform. The 4000 doctors to treat them. Such medical bill only recognises the role of psychiatrists in the professionals are concentrated in metros or two-tier treatment of a mental illness. It fails to acknowledge cities. This scenario is exemplified by numerous the roles of counsellors and psychologists who work other issues that result in mental health treatment with patients suffering from mental and emotional being insufficient. NIMHANS estimates that there distress. While mental illness is a ‘substantial are at least 35 lakh Indians who require disorder of thinking, mood, perception, orientation hospitalisation for mental illnesses. These patients or memory that grossly impairs judgement, are left untreated or are subject to inadequate behaviour, capacity to recognise reality or ability to medical infrastructure and specialists. Of the 40 meet the ordinary demands of life’; mental institutions capable of treating such patients, only 9 retardation is characterised by ‘incomplete are equipped to treat children. Moreover, many of development of mind of a person,’ which is not them are institutions with obsolete infrastructure included as ‘mental illness’. This differentiation with patients kept in solitary confinement. seeks to highlight the fact that Mental illness is not an intellectual disability, unlike mental retardation. Barely 1-2% of the health budget is dedicated to Mentally ill people are intelligent, and can take up mental health, in comparison to 10 –12% in regular employment, which could motivate them to developed countries. Given the stigma associated lead a productive life. Whilst this distinction is with any psychiatric illness, many of those suffering important, it does not exonerate the current Bill for continue to live with mental illness in the shadows, excluding the mentally retarded from the ambit of away from public view validating mental health mental healthcare. issue as a “hidden emergency” as per WHO. However, whilst the Bill mandates insurance The current budget is not enough to address the companies to provide medical insurance for the burden faced by the mental health system.