Simple phone calls help India to fight TB

In Mumbai and other Indian cities, a simple technology is helping combat the effects of a fragmented, underfunded public healthcare system by improving diagnosis and treatment of one of the world's most lethal diseases.

Private doctors were able to use mobile phones to call a specialist centre and receive e-vouchers - provided by the Brihanmumbai Municipal Corporation - for patients.

In recent, months more than 3,000 people received free, appropriate medicines to treat tuberculosis. Madhukar Pai and Puneet Dewan, health specialists, have described the scheme in an issue of the online journal PLOS Medicine.

They say: "New models are needed to engage informal and private sector healthcare providers, who dominate the healthcare marketplace in highly privatised health markets. National disease control programs, focused on public sector health services, have left these frontline care providers severely underutilised in TB control."

This new approach seeks to refocus attention and resources on early identification of infection and its more effective management, and to identify problems with treatment before they become too great.

It attempts to remedy the widespread underdiagnosis and inconsistent treatment of those in India with TB, a disease that kills 1.5m people each year globally.

A third of its victims have drug-resistant strains, partly due to inconsistent use - or inappropriate dispensing of - medicines. Much of this is the result of unsuitable prescriptions by private practitioners and drugs that are too expensive for patients.

The good news is a willingness by politicians in countries such as South Africa, Nigeria and China to allocate more of their own resources to fund a public health response to TB. However, many donor nations are also reducing support.

Lucica Ditiu, head of the Stop TB Partnership, says: "Sustainable healthcare requires investment in prevention, detection and response. We are in a different place for global visibility, with governments making domestic investments in the right areas. But it's like walking on a wire - you are moving forward but any wind will dislodge you."

She highlights concerns about "graduation" from donor programmes. As lower income countries' economies grow, this makes them ineligible for future grants.

And what applies to TB is equally relevant for other diseases. As Medecins Sans Frontieres said last month: "The Ebola outbreak [was] an exceptional event that exposed the reality of how . . . slow health and aid systems are to respond to emergencies. 'Business as usual' was exposed on the world stage, with the loss of thousands of lives."

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