Rashid Khan, 38, (name changed), a resident of Dharavi, recently visited a private doctor with classic symptoms of tuberculosis – hollow cough and persistent weight loss. His X-ray was conducted for free, his sputum tests for potential resistance to any TB drug were subsidised, and he got free TB medicines from the chemist's shop, until he was cured. He was among four thousand patients who were in a pilot project of the Brihanmumbai Municipal Corporation (BMC) to provide free drugs and diagnostics to patients seeking care under private doctors for TB.
Rashid Khan, 38, (name changed), a resident of Dharavi, recently visited a private doctor with classic symptoms of tuberculosis – hollow cough and persistent weight loss. His X-ray was conducted for free, his sputum tests for potential resistance to any TB drug were subsidised, and he got free TB medicines from the chemist's shop, until he was cured. He was among four thousand patients who were in a pilot project of the Brihanmumbai Municipal Corporation (BMC) to provide free drugs and diagnostics to patients seeking care under private doctors for TB.
The pilot project will scale up to serve the entire city from Monday onwards. BMC will start distributing electronic vouchers to TB patients. Using the e-vouchers, the TB patients will be able to claim their medicines for free from chemist shops. The e-voucher scheme will be unveiled on Monday by BMC Commissioner Sitaram Kunte.
"The standard of care for the patients seeking private care may vary from doctor to doctor. Expensive drugs and long treatment may lead to drop outs. Patients who do not take drugs regularly may develop resistance," said Dr Arun Bamne, TB Consultant, BMC.
BMC detects over 30,000 new TB patients every year. These patients are already receiving free care through Direct Observation Therapy Short Course (DOTS), funded by the central government. It is for the first time that BMC is funding the care of patients of private doctors as well.
Last year BMC, in 13 training programmes, trained 1,389 private doctors, including chest physicians, radiologists, general physicians, ayurvedic and unani doctors to mete out the right TB treatment to patients in high-burden areas of the city.
"Most trainings are targeted at doctors in the slums. Once a patient approached any of the empanelled doctors who have trained with us, they will counsel a patient and refer him to one of our 88 empanelled hospitals for a free chest X-ray. The patient's early morning sputum sample will be collected by the doctor and sent for a multi-drug resistance test for a subsidised rate of Rs 500, or no cost at all for poor patients," explained Dr Shibu Vijayan, project director, Programme For Appropriate Technology to Health (PATH), BMC's implementation agency for the e-voucher project.
The doctor will hand over the e-voucher number to the patient along with the drug prescription. On giving the e-voucher number to any of the 92 BMC-empanelled chemist shops, the patient will get free medicines for his TB treatment. "The patient will be hand-held and counselled by the doctors and the chemists to complete his/her TB treatment," said Dr Bamne.
Dr Vijayan said that every week, two SMSes will be sent to the patient's cellphone to remind them to take their medicines. Also every weekend, a phone call will be made by the call centre to the patient to ask them whether they are consuming their medicines regularly.
"If the patient is not adhering to the treatment, a health volunteer will visit the patient's house to ensure compliance," said Dr Vijayan. "Till date, 4,000 patients seeking care in the private sector have benefited from free medicines worth Rs47 lakhs supplied by BMC. We are going electronic from Monday onwards to make the process of disbursing medicines more transparent. The project funding is supported by the Bill and Melinda Gates Foundation," Dr Bamne said.
The Indian government has facilitated these projects involving e-vouchers, to patients seeking private sector care in three cities currently – Mumbai, Mehsana in Gujarat and Patna in Bihar. BMC and PATH are also in the process of formulating a smart phone mobile application to aid patients seeking TB care with private doctors. Moreover, Dr Sanjay Deshmukh, additional commissioner (health), BMC said, "In the next two months, we will also roll a policy to supply TB medicines from the BMC's side to private doctors."
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