Moradabad:

Project Information:

Tuberculosis is curable, yet millions continue to suffer and die from this disease each year.  India has the notorious distinction of the highest incidence and number of deaths from TB.

In 2007 there were more than 9 million new cases worldwide and close to 2 million deaths.  In India alone, there were 2 million new cases and more than 330,000 deaths. 

India’s Revised National Tuberculosis Control Program (RNTCP) provides free TB testing, medication, and treatment to patients throughout the country. The protocols follow the World Health Organization’s standard DOTS approach (Directly Observed Therapy Short-course), where each dose of medication in the intensive phase of treatment is directly supervised by a health worker. DOTS is a very successful model, but it requires a very high level of engagement from the care providers and trust from the community. Too often, it is apathy and distrust that characterize this relationship. The poor often turn instead to local physicians and pharmacists from their communities for immediate relief of their symptoms. Unfortunately, the care they receive is often substandard and costly, leading to high patient drop-out rates, further spread of the disease, and more deaths.

The failure of an existing TB program can be much worse than no TB program at all.  Patients receive just enough TB medicine for their symptoms to subside, but they are not cured. Resistance to the drugs can develop and the disease can return as a much more deadly multi-drug resistant strain (MDR-TB). This strain is extremely difficult and expensive to treat, and can now be directly transmitted to new patients. For most patients, a diagnosis of MDR-TB is simply a death sentence.

Stopping the spread of TB and MDR-TB is fundamentally a problem of health care delivery. New medicines and diagnostic tests may help, but neither is necessary nor sufficient. Real improvements will come by injecting urgency, commitment and responsibility in the last link between health care workers and patients.

A new model for creating community-based TB programs has recently been developed by a non-profit organization called Operation ASHA and tested in the poorest slums of New Delhi. The strength of their approach lies in recruiting health workers from within the communities and creating a system where the workers have a strong incentive to ensure successful treatments and find new patients. Drug dispensaries are located in small stores or kiosks that are open 7 days a week, addressing the problem of frequently closed government-run treatment centers.

The improvements have been dramatic. Cure rates and detection of new cases have increased multiple times. Because this program works with the existing RNTCP of India, each new treatment center is eligible for a government grant after two years of operation that will cover its entire operating cost, thereby ensuring its sustainability. This model has been very effective so far.  Now it needs to be tested and spread to more communities. More funds are required to set up new centers to cover their first two years of operation.

Project Location:

Moradabad is a mid-sized city of roughly 650,000 located on the banks of the Ramganga River, just over 100 miles outside of New Delhi. Known locally as Peetal Nagri, or “Brass City”, the city is renowned for its highly skilled artisans producing beautiful and intricate brass handicrafts. Working out of modest workshops in houses and small factories, these craftsmen have gained international recognition by exporting their brassware across the world.

Moradabad is also known for the poverty of much of its population. Tuberculosis incidence is high; especially in the crowded slums where access to treatment is severely limited. The predominantly Muslim population is unfortunately underserved by the existing TB treatment programs. Local clinics and “compounders” (dispensaries) fill the gap by providing sporadic treatment, usually at a high cost for the patient. In this situation, patients suffering from TB may never be correctly diagnosed or may start, but then fail to finish the full treatment. When TB drugs are available, but the treatment program is failing, the danger of MDR-TB is a serious concern for the entire community. In Moradabad, government sponsored medication is available free of charge, but patients continue to die due to a poorly functioning delivery model.

Prajnopaya Foundation and Operation ASHA are working with the Moradabad TB control program to bring their successful community-based TB model to the poor communities in Moradabad. By the end of 2009, we plan to open eight treatment centers in Moradabad that will provide treatment for roughly 800 patients per year. The counsellors will be recruited from the local residents and the treatment centers will be set up close to the patients’ homes, usually in small stores or kiosks that are open at least 12 hours a day. 

The model has worked in Delhi and elsewhere. It is self-sustaining with government funding after two years, but your support is needed to get it up and running. Please consider making a contribution that can have a real and lasting impact.

How can you contribute:

*The cost per patient does not include medicine or hospital and diagnostic services. In the present program, these will be covered by the Indian National Tuberculosis Control Program.