When the coronavirus pandemic hit India, many were worried that the country's overworked public healthcare system would not be able to cope with the added burden of the outbreak. The crisis has brought to light the flaws and discrepancies of India's health outreach programs.

National outreach programs for infectious diseases such as tuberculosis (TB) and HIV have become severely underfunded and put on the back burner due to a shift of focus to limiting COVID-19 infections. But health professionals warn that such a move could have detrimental effects on India's population in the future.

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TB far deadlier

COVID-19 has so far claimed more than 17,000 lives in India. Yet tuberculosis remains a far more fatal disease for the South Asian country. The highly infectious disease claimed over 79,000 lives in 2019 alone, according to the latest annual TB report.

A recent joint study by the London School of Hygiene & Tropical Medicine and Lancaster University projected that the pandemic could add at least 110,000 more fatalities in countries including India, China and South Africa. The researchers also noted that the crisis could result in overall decreased clinic attendance as well as delayed diagnosis and treatment.

However, India's minister for health and family welfare, Harsh Vardhan, commended the country's progress for handling its TB crisis. "The government is committed to achieving the Sustainable Development Goals of eliminating TB in the country by 2025, five years ahead of the global target," he announced.

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But Saurabh Rane, an advocate for Survivors Against TB – a community-based initiative led by TB survivors – said since the outbreak of COVID-19, "it has been an absolute nightmare for [TB] patients."

Rane, who is a TB survivor himself, said that while most patients reach out to understand how to deal with the stress and anxiety caused by the pandemic, "they don't know if they can get the tests done in time, get time from their doctors for consultations or even procure their next batch of medications."

Rane believes one of the greatest failures of India's healthcare system has been the lack of communication and outreach from the New Delhi government. "If the system has not faced this before, the patient hasn't either. Communication opens a channel to understand their problems and that is when you can find solutions for them. Increase bandwidth on the helpline, provide them chat options, figure out doorstep drug delivery mechanisms, create spaces for testing, and troubleshoot problems as they occur," he said, adding: "The public health system has to fight an old pandemic in the middle of a new one."

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Getting hold of HIV medication amid lockdown

India is home to the world's third largest population of HIV+ patients. The Indian government provides lifelong ART (anti retro-viral) medication to all registered patients.

But when the nationwide lockdown was in place, many HIV sufferers couldn't visit the hospital or clinic facilities to obtain the necessary medication due to the shutdown of public transport.

"Adherence is key to taking ART and for a total suppression of the HIV virus. It is non-negotiable, simply because we can't negotiate with our virus. If we miss say 2-3 doses in a month or if we do not adhere at least 97% of the time, the virus can bounce back and we are likely to develop resistance," said Loon Gangte, co-ordinator of the Delhi Network of Positive People – an initiative aimed to improve the lives of people living with HIV.

Even as restrictions are gradually lifted, those living with HIV still face fear and distress on a regular basis. Gangte says the situation is worse for low-income HIV patients as well as ostracized members of society such as sex workers and transgenders.

Despite the easing of lockdown measures, experts warn that Indians suffering from highly infectious diseases other than the coronavirus remain in a vulnerable position.

"People should not be deprived of treatment as they too have their right to health. We urge the government not to abandon initiatives on HIV/AIDS, TB, and drug addiction," said Abu Mere, president of NNagaDao, a local non-governmental organization.

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