CHENNAI, 14 February 2018: At least three out of five people, particularly in rural areas, choose to visit private healthcare facilities for tuberculosis treatment before they enrol for free treatment at state-run hospitals including primary health care centres, a study by a group of scientists has found. This has led to a delay in starting treatment - a critical factor for preventing complications and spread of TB in the community, the authors said. It also increased out-of-pocket expenses for the patients by nearly 17 times, said the descriptive study, ‘Diagnostic pathways and direct medical costs incurred by new adult pulmonary TB patients prior to anti-TB treatment – Tamil Nadu, India,’ published on Wednesday in an open access medical journal PlosOne.
India accounts for one fourth of the global TB burden. In 2015, an estimated 28 lakh cases occurred and 4.8 lakh people died due to TB. According to the Union health ministry data, a large number of people continue to access facilities at private hospitals before approaching government centres. “This despite the huge investments towards free diagnosis and treatment in public facilities,” said the study’s corresponding author Dr Shantidani Minz, from the department of community medicine, Christian Medical College. “The quality of treatment offered at all private hospital is not uniform. Studies have also shown that TB treatment in India is sub-optimal,” she said.
Before the large-scale DOTS programme was implemented in Tamil Nadu, only a quarter of TB patients went to public hospitals for treatment, but after the free treatment was introduced the number went up to 61% at public hospitals. The Vellore- study has once again reversed the trend as only 35% of study participants preferred government hospital as first point of care.
The research team conducted part of a randomised control trial in three rural TB units in Vellore for three years from December 2012 where 880 patients were interviewed. More than two-thirds of the participants did not attain a secondary level of education and an almost equal number of them were daily wage earners either in agriculture or industrial sectors with an average monthly individual income was around 5,000.
The district had 101 primary health centres, 13 secondary referral hospitals, and one referral hospital (Vellore Medical College Hospital), where tuberculosis services such as diagnosis and treatment were offered free of cost through the Revised National TB Programme. The district also has one private tertiary care hospital, Christian Medical College, several private hospitals and clinics.
During the study, doctors found that patients visited up to four health care facilities before starting on anti-tuberculosis treatment.
Nearly 65% visited private hospitals and less than 1% of the people preferred traditional form of medicine.
But among those who visited public hospitals 68% were started on treatment compared to 11% in private hospitals. The others went “to a myriad of other health facilities before treatment initiation”, the study found.
Patients who visit visited private hospital also spent at least 830 more compared to those who visited a public health facility, where they don’t pay.
The authors of the study have highlighted the need for public facilities to made first choice of treatment. “People may not be coming to these centres because these most of these centres function only in the morning but people don’t wan’t to skip their daily wages to meet a doctor,” said Dr Minz.
Senior public health experts say the state must look at novel ways such as evening clinics so more people can make use of their facilities. “More people will come in the evenings if these centres are open,” said former public health director Dr S Elango.
Source: The Economic Times