The need to further augment the public health system

The need to further
augment the public
health system to control
We completely agree with
Madhukar Pai and colleagues1 that a
complete and patient-centric solution
to tuberculosis control should be
delivered with dignity and compassion.
India’s Revised National Tuberculosis
Control Programme (RNTCP), which
was recognised as one of the best-run
tuberculosis control programmes in
the world, has only been able to provide
27% of patients with multidrugresistant tuberculosis with treatment,
which is worrisome. Pai and colleagues
vouch for patient-centric solutions
for complete treatment. However,
they do not emphasise the fact that
most of India’s population is served by
the public health system, with varied
quality of services delivered. The scope
for the tuberculosis control programme
has been increasing from 2006 when
the whole country was immunised,
and there was a drive to strengthen the
programme in the areas of tuberculosis
and HIV co-endemicity, drug-resistant Vol 2 July 2014
tuberculosis, tuberculosis–diabetes,
and tuberculosis notification, without
any major modification to the available
human resources. The degree of
integration expected from the general
health system by the RNTCP was not
fully achieved; the onus of treatment
of a patient with tuberculosis always
remained with the RNTCP, rather than
the health system. We urge that the
public health system in the country
is augmented with new workforce
strategies and policies to retain human
resources and deliver appropriate care
to the community. The proportion of
gross domestic product spent on health
is a meagre 4·1% in India, whereas
developed countries, such as the USA,
spend more than 17·1% on health care.2
The private health sector in India is
uncontrolled. Strategies and models
implemented in a particular place
might not be easily replicable in other
places. Engagement with the private
sector is only a small part of how best
to improve health care; strengthening
of the public health sector is vital in
In conclusion, a complete and patientcentric solution can be provided by
augmentation of the RNTCP, in terms of
good governance of the health system,
new technologies, increased investment
in the general health system, and
political and administrative will to
implement high-quality services for
tuberculosis care. For delivery of services
under the national health programme
in a vast country such as India, no
replacement for the public health
system exists.
We declare no competing interests.
Copyright © Nagaraja et al. Open Access article
distributed under the terms of CC BY.
*Sharath Burugina Nagaraja,
Ritesh G Menezes
[email protected]
Department of Community Medicine, Employees
State Insurance Corporation Medical College and Post
Graduate Institute of Medical Sciences and Research,
Bangalore, India (SBN); and College of Medicine,
King Fahd Hospital of the University, University of
Dammam, Dammam, Saudi Arabia (RGM)
Pai M, Yadav P, Anupindi R. Tuberculosis
control needs a complete and patient-centric
solution. Lancet Glob Health 2014; 2: e189–90.
World Bank. Health expenditure, total (% of
GDP). 2014.
indicator/SH.XPD.TOTL.ZS (accessed March 30,