Executive Summary
The coronavirus pandemic in India has awakened one of the country’s top health problems, namely Tuberculosis (TB). Public clinics sacrifice other services to address the COVID-19 issue, while private medical facilities charge prices beyond the reach of the most damaged social groups. The problem was analyzed, and two interventions were developed: TB health promotion via popular social networks and support from the Indian armed forces. A health promotion program is a more cost-effective and safe intervention compared to the second one. Moreover, it was found to be more suitable to the current Indian context. Cooperation of governmental health and economic entities in developing health promotion strategies, modern digital marketing, and collaboration with media giants and social media influencers have every chance to significantly increase public awareness of TB and reduce infection incidence.
Introduction & Background
India is a developing country, both socially and economically. It still struggles with several mass diseases, such as human immunodeficiency viruses (HIV) and TB. Researchers note that “India has the third-largest HIV epidemic in the world, with 2.1 million people living with HIV” (HIV and AIDS in India, 2020, para. 1). Recently, the COVID-19 pandemic has become a new challenge for the country’s public and private health care. While Indian healthcare providers are focused on dealing with the latest variants of the coronavirus, TB could once again become a massive disease in the country. This paper aims to develop, propose, and describe several measures to prevent the TB epidemic in India during the COVID-19 crisis.
Nowadays, a rising number of TB patients is a major challenge for health professionals in India, and the ongoing COVID-19 pandemic is only making it worse. According to official statistics, “India has the world’s highest incidence of TB, with 2.8 million cases annually, and accounts for more than a quarter of the global TB burden” (USAID, 2019, para. 3). Unfortunately, India was one of the countries most hit by the COVID-19 pandemic; the overall situation here can be described as a health crisis. Such a sorry state of affairs is primarily due to the long-standing problems of the Indian healthcare system, which are outdated and underdeveloped infrastructure, lack of funding and equipment, insufficient professional skills, and knowledge of the medical staff (Rannard, Shah, & Bramwell, 2021). The coronavirus pandemic forces government and private healthcare providers to redirect available resources and efforts from people with TB to COVID-19 patients. It poses the threat of a tuberculosis epidemic not only in India but also throughout the world. As one can see, a well-developed public health intervention is needed to prevent an upcoming epidemic.
Overview of Government Regulations Related to the Issue
As noted above, TB has always been a top-priority health issue for the Indian government. For example, public healthcare providers provide free TB screening, diagnosis, and treatment to all Indians (Coasara & Pai, 2017). In this decade, a new national approach to TB control and prevention was announced in 2017 by Indian Ministry of Finance officials. According to Coasara and Pai (2017), “on February 1st, India’s finance minister presented the Union Budget for 2017-2018 and announced the government’s plan to eliminate tuberculosis (TB) by 2025” (para. 1). The plan includes a comprehensive approach to improve services related to the diagnosis and treatment of TB and patients outcomes (Coasara & Pai, 2017). Moreover, it also provides significant financial incentives for healthcare workers and patients actively participating in this program (Coasara and Pai, 2017). The end goal of the government is to eliminate the condition entirely by 2025.
The United States (US) is also helping the Indian government fight TB. The US Agency for International Development (USAID) is the entity responsible for supporting Indian healthcare. Official sources claim that “USAID is a strong partner to the Government of India and has supported the country’s Revised National TB Control Program (link is external) (RNTCP) since 1998” (USAID, 2019, para. 10). The organization provides financial and technical support to both public and private healthcare sectors (USAID, 2019). It also helps Indian authorities to implement healthcare initiatives and conduct TB research (USAID, 2019). The result of this cooperation is a significant improvement in the detection and treatment of the condition.
Evaluative Criteria
Political
When analyzing a problem, especially one belonging to the field of health care, identifying evaluation criteria significantly helps find the most effective solution. The PEEEEL approach will be used in this policy brief to find and describe these criteria. The first one is of political nature, and it is public awareness. Financial incentives for participants in the national TB eradication program indicate that the population of India is poorly informed about this condition and its prevalence in the country (Coarasa & Pai, 2017). Therefore, it is safe to say that Indian citizens have little public awareness of the deteriorating quality of TB care and the possible TB epidemic. Public awareness is one of the main criteria by which the productivity of the proposed below intervention will be measured during implementation.
Epidemiological
The epidemiological criterion in this policy brief is the prevalence of TB infection in the Indian population. This criterion allows one to assess several factors associated with the problem at once. The high number of patients with TB conditions indicates that the healthcare system does not have the capacity to deal effectively with the situation. The researchers also note a decline in the number of registered TB patients undergoing treatment in 2020 (Shrinivasan, Rane, & Pai, 2020). This, as well as the many new cases that are constantly appearing, shows that the condition is spreading widely.
Economical
The coronavirus pandemic has made all medical facilitators in India, mainly public-funded ones, rethink their financial policies. COVID-19 screening, diagnosis, and treatment have proven to be highly costly for Indian hospitals and clinics. That is why they began reallocating resources from other areas of responsibility and raising prices for services and medications (Punj, 2021). They are trying to offset the significant costs caused by the coronavirus crisis. The factor of cost-effectiveness of medical procedures directly affects the access and quality of TB care and treatment.
Ethical
Economic inequality and social stratification, almost on the brink of the social divide, have always been the fundamental problems of Indian society. Low-income people in India have minimal access to private healthcare providers (Punj, 2021). Public health facilities are operating at full capacity, and the price of non-governmental TB services is too high for the most vulnerable social groups. The pattern is clear, as unequal access to health institutions aggravates the TB crisis. Equal accessibility is another criterion by which one can partially assess the extent of the TB problem in India.
Legal
The government’s regulations overview section has detailed how the Indian government perceives the TB problem. Simply put, Indian officials consider TB eradication as one of its main domestic policy goals (Coarasa & Pai, 2017). The history of anti-TB policy in India shows that the more the high officials try to combat the condition, the better the overall result (USAID, 2019). The degree of government involvement in health programs is a legal criterion that allows one to analyze the issue under discussion and predict its outcomes.
Alternatives
Status Quo
As noted previously, the Indian government is currently struggling with allocating resources and efforts between different patient groups. Their top priority goals now are detecting and treating people with COVID-19 and eliminating the local coronavirus epidemic (Rannard et al., 2021). Even support from the United States and private American pharmaceutical companies is not enough to equally redistribute medicines, equipment, and services to people with respiratory conditions. The global COVID-19 epidemic has significantly slowed down the progress of the national anti-TB plan. There are high chances of a syndemic occurrence, which could give rise to new coronavirus types that threaten the entire world community. Comprehensive measures and policies need to be developed to prevent a looming TB crisis.
TB Health Promotion via Popular Social Networks
In times of scarcity of finances, equipment, and human resources, the health system can delegate several responsibilities to the community they serve. A thematic TB health promotion program via social media may become a temporary solution to a worsening situation. Almost half of the Indian population has access to online space and actively uses multiple social media (India social media statistics 2021, 2021). The Indian government, namely the Ministry of Health and Family Welfare of India, can develop a health promotion strategy to spread awareness of the country’s TB crisis via YouTube and Facebook, the country’s most popular online platforms. Utilizing digital technologies, Indian health workers and officials can educate all segments of the population, especially residents of remote areas and those with weakened immunity, on avoiding and detecting TB infection and how family members can help their relatives treat the condition properly. By producing thematic series of health promotion videos, such as how to take medications for multidrug-resistant TB patients, healthcare providers can reach all patient groups, even the most vulnerable ones.
Asking for Support from the Armed Forces
There is another alternative that could potentially solve the current problem. The Indian government can request support from its armed forces to help prevent, control, and treat TB in remote areas and places with insufficient infrastructure, and financial and human resources. India has one of the largest armies in the world, with nearly 1.5 million personnel (The biggest armies in the world, 2021). It is safe to say that there are enough military medics to assist all health workers all over the country. Military hospitals can temporarily serve as special TB and respiratory civil clinics and hospices after training military doctors.
Analysis
Status Quo, Arguments for
As one can see, a quick and comprehensive response to the TB situation in India is needed. The lives of many patients are at risk due to deficiencies in the Indian health system and the global COVID-19 pandemic (Rannard et al., 2021). In addition, current challenges could significantly damage the public and private health industry in India, leading to the slowdown and termination of many important healthcare initiatives and programs.
Status Quo, Arguments against
The current hardships that the healthcare system in India experiences right now are of temporary nature and will soon end. The peak of COVID-19 has long since passed, and effective avoidance and prevention measures have also been developed. Moreover, scientists have developed several options for effective and safe vaccines, and their mass production in India will soon (Reuters Stuff, 2020). Simply put, the Indian government can tackle both the COVID-19 pandemic and the growing TB epidemic with the existing resources and support.
Arguments for TB Health Promotion via Popular Social Networks
Health promotion is a cost-effective measure to improve the physical and mental well-being of the population. Cost efficiency and cost-benefit are critical factors in this case since public Indian health care is extremely limited in all types of resources now (Rannard et al., 2021). It is also worth noting that the proposed approach does not require significant human resources. It also does not need the equipment and medicines that are so needed by many Indian TB patients at the moment. The strategy fits all the limitations that the described issue has.
Arguments against TB Health Promotion via Popular Social Networks
In order for the TB health promotion program to be noticed by a large number of Indian viewers and become effective, it needs advertising. The Indian government will need to collaborate with popular Indian social media influencers from all social and age groups to reach as many people as possible. It is worth mentioning that the Indian online audience is very diverse and numerous (India social media statistics 2021, 2021). Moreover, Indian officials will have to buy ads from YouTube and Facebook, which is also costly. Therefore, this measure to prevent the TB epidemic can be much more expensive than it seems.
Arguments for Asking for Support from the Armed Forces
Indian health care urgently needs support to fight the upcoming syndemic. The medical corps from the Indian Armed Forces are what the public health providers need right now. They can go to underserved regions; they only need special training that does not take long. They will also gain crucial medical experience that could be applied later to help the government fulfill the promises made in the national plan, namely the eradication of TB by 2025 (Coasara & Pai, 2017). As previously mentioned, its implementation has been undermined by the coronavirus crisis.
Arguments against Asking for Support from the Armed Forces
The involvement of military forces in solving the TB issue could potentially endanger both the Indian army and the country’s security. There are always mistakes made in practice, even after receiving detailed training. In this case, even the slightest one can lead to a TB epidemic within the Indian army. It could significantly undermine India’s defenses, which is unacceptable with neighbors such as China and Pakistan (Singh, 2021). It would also add new problems for the health care system of the country.
Final Recommendation
The author of this policy brief thinks TB Health Promotion via Popular Social Networks is the most appropriate option. Indian medics and authorities should start with a detailed analysis of the current TB population. Further, medical professionals should develop a health promotion program based on the data obtained and the interpreted results. It is essential to mention that the program should consider the ethnic, cultural, religious, linguistic, and dialectic differences of the Indian population. When the development of the health promotion policy is completed, digital marketing begins. Government officials from the medical and economic sectors responsible for implementing health promotion programs start to collaborate with local social media influencers and build partnerships with YouTube and Facebook. Professionals should make a collaboration decision based on the influencer’s reach, audience size, and advertisement cost. The health promotion campaign should last until the end of the local COVID-19 epidemic. Only after the coronavirus crisis will it be possible to return resources and equipment from COVID-19 patients back to TB ones.
Limitations
The proposed policy to improve the TB situation in India will only take place online. It does not include any actions or practices in clinics and hospitals. It is also worth mentioning that the success of a health promotion program depends more on Indian government officials’ partners, patients, and recipients than on its creators. State control over the course of the health promotion program becomes limited immediately after its official launch.
Conclusion
This work presents a policy brief to address the upcoming TB crisis caused by the parallel coronavirus pandemic. Here one can find an explanation of the current state of affairs in Indian health care. An analysis of the issue under discussion through the five PEEEL criteria is also provided. Two solutions have been developed to alleviate the current near-crisis situation in India. Consequently, TB health promotion via popular social networks was chosen as the most optimal strategy.
References
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Rannard, G., Shah, D., & Bramwell, K. (2021). India’s covid crisis: Your questions answered.
Reuters Staff. (2020). Modi says India set to mass-produce COVID-19 vaccine, launches digital health mission. Reuters.
Shrinivasan, R., Rane, S., & Pai, M. (2020). India’s syndemic of tuberculosis and COVID-19. BMJ Global Health, 5(11), 1-5.
Singh, S. (2019). The challenge of a two-front war: India’s China-Pakistan dilemma.
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