Economic impact of Tuberculosis in India

Tuberculosis (TB) exacts a significant economic toll in India, affecting individuals, households, and the nation’s economy as a whole. Despite being preventable and treatable, TB continues to pose formidable challenges, impeding economic development and exacerbating poverty. By delving into the economic dimensions of TB in India, we can better understand its impact and the urgent need for concerted action to address this burden.

The economic burden of TB encompasses direct costs related to healthcare services and indirect costs stemming from productivity losses and premature mortality. According to a report by the World Health Organization (WHO), TB costs India an estimated $24 billion annually in terms of lost productivity and healthcare expenses. This staggering figure underscores the magnitude of TB’s economic impact on the nation.

Direct costs of TB care include expenses incurred for diagnosis, treatment, and management of the disease. These costs can be prohibitive for affected individuals and households, particularly those already grappling with poverty. According to the Global Tuberculosis Report 2021, approximately 39% of TB patients in India face catastrophic health expenditures, pushing many families into poverty.

Indirect costs of TB are equally significant, primarily attributable to productivity losses resulting from illness, disability, and premature death. TB often strikes individuals during their prime working years, disrupting employment and income-generating activities. A study published in The Lancet estimated that TB-related productivity losses in India amounted to $340 million annually, reflecting the substantial economic impact of the disease on workforce productivity.

Moreover, TB-related stigma and discrimination can exacerbate indirect costs by impeding social integration and employment opportunities for affected individuals. Fear of transmission and discrimination in the workplace further compound the economic hardships faced by TB patients and their families.

  • India bears the world’s highest burden of TB, accounting for approximately one-quarter of global TB cases.
  • In 2022, there were an estimated 2.8 million incident TB cases in India, with 342,000 TB-related deaths.
  • TB disproportionately affects economically vulnerable populations, including the homeless, slum dwellers, migrants, and marginalized communities.
  • The economic impact of multidrug-resistant TB (MDR-TB) is particularly severe, with higher treatment costs and lower treatment success rates compared to drug-susceptible TB.
  • According to the India TB Report 2021, the economic burden of TB in terms of lost productivity and healthcare costs is estimated to be $32 billion annually, representing a significant drain on the economy.
  • According to The Economic Times, the total cost of TB treatment from the onset of symptoms to one year post-treatment ranged from $330-$375 per PwTB, despite free diagnosis and treatment provided by the government.

Efforts to mitigate the economic impact of TB require a comprehensive approach that integrates health system strengthening, social protection measures, and poverty alleviation strategies. Investing in accessible, affordable, and high-quality TB care services is essential for reducing the financial burden on affected individuals and households. Additionally, addressing social determinants of health such as poverty, malnutrition, and overcrowded living conditions is critical for preventing TB and breaking the cycle of disease and poverty.

Furthermore, enhancing TB control efforts through innovative financing mechanisms, public-private partnerships, and community-based interventions can help alleviate the economic burden of TB while advancing progress toward elimination goals. Prioritizing TB within broader health and development agendas is essential for mobilizing resources, galvanizing political commitment, and fostering multisectoral collaboration to tackle this pervasive public health challenge.

The economic impact of TB in India is substantial, exerting profound consequences on individuals, households, and the nation’s economy. Addressing this burden requires concerted action and sustained investment in TB prevention, diagnosis, and treatment services. By leveraging evidence-based interventions, strengthening health systems, and addressing social determinants of health, India can mitigate the economic impact of TB while advancing progress towards achieving health equity and sustainable development goals. As India strives towards a TB-free future, addressing the economic dimensions of the disease is paramount for fostering inclusive growth and improving the well-being of its citizens.

(First published on LinkedIn on 28th March 2024)

Social Capital in India: Old wine new bottle

Photo source: http://entrepid.sg

India faced the problems of economic development and poverty eradication twice on a massive scale. Firstly, it was felt acutely just after independence and secondly, it is being felt still more acutely, today, when under the pressure of globalization, India has to turn to United States of America and western countries for its development. When Indiabecame independent from the British rule in 1947, Pt. Jawaharlal Nehru as the first Prime Minister of India, felt the need to develop an independent economic system. To strengthen independence and make it more meaningful for the common man, the issue was hotly debated. The American and western experts termed the debate on independent economic system as a futile exercise. They argued that as India was divided into so many castes, religions, languages and regions it could not create a large, well organised market system. They believed that Indians were people with spiritual leanings who cared more for the world here after. And therefore, it was believed that these Indian common men had little interest in savings or profit making. They even quoted Shankaracharya, in their support whose teachings said, ‘O fools, wealth can never give you satisfaction. So renounce all desires. Be wise and contented and happy with your lot.’

In this way the western masters did all they could to dissuade India from modern industrialisation. But JL Nehru and the subsequent PM Smt. Indira Gandhi never felt discouraged and made concerted efforts to develop an independent economy and achieved unprecedented success in this direction.

Surprisingly enough, these advisors have appeared again, this time in the form of institutional system like World Bank. They claim that lack of Social Capital is at the root of growing socio-economic disparity, corruption and rising crimes in the country. Therefore,India should desist from opposing international economic system (as witnessed inCancun) and make an all-out effort to create Social Capital. Robert Putnam, Francis Fukuyama and World Bank worked as Think Tank behind this campaign. Putnam was the chief exponent of the modern concept of Social Capital. He discussed this concept in detail in his famous book, ‘Making Democracy Work: Civic traditions in Modern Italy’ published in1993. In his opinion ‘Social Capital’ is closely associated with the kind of social organization which is based on mutual trust and accepted standards of social conduct. These elements work as networks that develop the work culture of the society that pave the way for combined social efforts for economic progress and prosperity. In other words, ‘they create a social affinity that helps people work together and thereby increase production’.

Francis Fukuyama underlined the importance of ‘Social Capital’ in his book ‘Trust and the Great depression’. He further emphasised its role in his pamphlet ‘Social Capital and Civil society’, which he wrote for International Monetary Fund. According to Fukuyama Social Capital is essential for modern economy to function efficiently. No liberal democracy can function without it nor can modern culture survive without it.

World Bank considers Social Capital as the lost link of development. The concept of Social Capital with its inherent implications is not entirely new for India. Right form the ancient times people were instructed to work together. It has been the basis of joint family, caste-system, society and religion. Lord Buddha preached, ‘Sangham Sharanam Gachhami’. Today it is said that ‘strength lies in unity’ (‘Sanghe Shakti Kalyuge’ in modern times). The question is if we already know the importance of Social Capital, it means that there is nothing new in the concept. It is only old wine in a new bottle. Then what is the justification for launching such a great campaign again!

The reason is not far to seek. Western countries and their experts and their mouthpieces in the form of Organizations viz., International Monetary Fund and the world bank, nourished by them do not want that developing nations should see their economic backwardness and mismanagement in their historical perspective and take positive steps to redress them. Nor do they want that these nations should launch a crusade against the present unjust International economic system. These western powers want that the developing countries should follow their dictates, in every area of economic development, as modern day economic colonies. So, they try to convince the people of the developing Countries that they alone are responsible for their present miseries. If they stop fighting among themselves and create an atmosphere of mutual co-operation and trust they will progress with rapid speed.

It is useless to blame Capitalism and Imperialism. If land-lords and farm-workers, Capitalists and imperialists, forwards and backwards, developed and developing nations shun the path of confrontation and live amicably by creating mutual trust, the problems of poverty, exploitation and backwardness will be solved in due course. The spokesmen of the present concept of Social Capital strongly believe that in a country like India, the root and source of Social Capital still exist, but they can be revived not by Government machinery but by non governmental organizations. As the present political system has become utterly corrupt, these organizations should keep above politics while discharging their duties.

They are opposed even to Gram Panchayat and decentralisation because they are fully under the control of the Government. In this way, they want to keep all developmental work beyond the jurisdiction of the government. The supporters of Social Capital are in the favour of making all development work non-political. They have faith only in non-governmental organizations. But as we all know that these NGOs are not above controversy. Most of them are interested only in earning money by fair or foul means. They receive money from many donor agencies, which are not above suspicion themselves. The data collected by NGOs may be used by the foreign agencies against the government, which may go against our national interests. In short, these so called NGOs are not free from corruption. More over, the Social Capital generated by NGOs is not equally used for the benefit of every section of the society.

Today India needs all-round social, economic, political and cultural changes to create congenial conditions for development. This is a tremendous task which can be accomplished by political parties alone by using people’s power. This is because; the party in power is answerable to the people and the parliament. The NGOs which create Social Capital do not own any such responsibility. In India, NGOs like Ram Krishna Mission, Bharat Sevashrana, etc have been functioning for decades. They have done commendable work, but have never claimed that they can bring about comprehensive economic and political development. Today NGOs which are known for their integrity can not do more than providing temporary relief. However, permanent changes can be brought with a proactive partnership between the government and the civil societies. Therefore, it is wrong and even dangerous to think of development without government and political power.

In the end attention should also be drawn to the fact that some people want to encourage casteist, regional and communal organizations in the name of creating and developing Social Capital. It is a signal of danger which should be taken note of. If Brahmins form their organization to help their kinsmen and backward and schedule castes work on the same lines, it will aggravate only sectarian feelings. India, which is already divided on sectarian lines will break into fragments if programs of Social Capital are implemented with such narrow minded aims and ambitions.