Are we winning against Tuberculosis?

It is now 2008,more than 40 years after the discovery of Rifampicin, the most potent drug against Tuberculosis.The 3 or 4 drug cocktail that includes Rifampicin almost always work against Tuberculosis.These drugs are available free of cost at Government health units through out India.Still TB is rampant and some say it is increasing.It is estimated that about 1 in 3 of new TB infected patients do not get access to the Govt run TB control programme. Even if they get access it is not properly utilised.
Last week I started anti tuberculous medicines in 5 patients,3 of them on the same day. I offered them reference to Govt TB control facility.I told them that they will get the drugs free of cost and that the drugs are of good quality.But only one, a poorly paid nursing trainee took the offer.Others were not rich but were ready to spend money from their pocket for the medicines.Why?
Their confidence in approaching the Govt run TB control centre was low.One reason is such centres are notorious for lack of efficiency. Patients may have to go there several times before they get the medicines.Timings of such centres are such that the patient will have to sacrifice few of his/her working days.Also there is stigma associated with queuing up in front of the crowded TB centre.When drugs are available in private pharmacies at a reasonable cost [as there is a Govt control on prices] why should one take all the pains to get those medicines free?
Inefficiency,lack of privacy,unsuitable working hours,ignorance of the public etc are some of the reasons behind the lack of success of TB control programme even in a literate and health conscious,Semi-urban State of Kerala.So we can very well imagine the plight of the programme in other States of India.