This section presents actionable insights for practitioners from our collaboration of experts.
Meet one of India’s most prolific killers: Of India’s estimated 2.8 million new cases of tuberculosis (TB) last year, over 4 lakh among them succumbed to the disease. That’s almost 1100 victims every single day.
Among TB’s most frequent victims — in terms of both infection rates and mortality — are the Sahariya tribe in Madhya Pradesh. At any given time, 1,518 out of every 100,000 Saharia people living in Sheopur district, and over 3,000 in the district of Gwalior, are suffering from TB. By way of comparison, the prevalence per lakh population for the rest of India is just 211, and for the Baiga and Bharia tribes, neighbors of the Sahariyas, the numbers are 146 and 432 respectively. Besides being infected seven times as often, Sahariyas also experience very low success rates in TB treatment: In some villages, ‘every third house has a TB widow’, and Sahariya people are twice as likely to have Multi-Drug Resistant (MDR) TB, which is much harder to cure.
Photo credit: Hindustan Times
So what makes the Sahariyas the perfect victims of TB?
Five key factors, well known to the experts, are at play here.
Photo credit: Dainik Bhaskar
The Mystery, Revealed
We already know that tribal populations are more vulnerable to TB — the National Strategic Plan for TB control mentions them as a high-risk group. We know that migrants are more susceptible to TB as well — in fact, we know well the evidence that links each of the factors mentioned above to the risk of dying from TB. The real mystery isn’t why the Sahariyas are getting ill, but why we aren’t able to change this, despite knowing so much about it. In fact, what the Sahariya case shows is that our approach to treating communities at high risk from TB is inadequate. There are three particular gaps in how we address these groups, which urgently need to be plugged:
If we get our strategy right with the Sahariyas — given their high prevalence of infection, difficult socioeconomic conditions, and constraints to healthcare access — we can replicate the model for others as well. Every TB patient will benefit. Our healthcare system has harbored this fugitive for long enough. It’s time we put in the resources needed so that justice can be done.
Rhea John is Learning Catalyst at Swasti.
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