Mumbai Mission for Tuberculosis (TB) Control, India

People, including the poor, often seek care for sickness at the numerous private clinics in the city. The city had a centralized model of delivering TB care which led to issues related to access, delays, long wait lists, stigma, and risk of transmission of drug-resistant TB in overburdened health facilities.

In 2011-2012, activists and the media very effectively highlighted the problem of drug resistant TB in Mumbai. In March 2013 a comprehensive plan for Universal Access to quality TB care was launched, the "Mumbai Mission for TB Control". Mumbai Municipal Corporation with its own public and private health sector and in collaboration with national TB programme, and partners such as Bill Melinda Gates Foundation(BMGF), WHO Country Office and others formulated the Mumbai Mission for TB control with following strategies: (1) Mission mode active case finding in slums, (2) Access to rapid diagnostics including universal drug-susceptibility testing, (3) Improving access to effective treatment, (4) Extending services and support to providers and patients in private health care sector, (5) Infection control, (6) Building empowered communities and (7) Organizational strengthening.

The municipal corporation contracted a public private interface agency (PATH) with grants from BMGF and initiated engagement of informal healthcare providers through a network of hub centres to improve access and quality of diagnostic and treatment in slums of the city. Re-enforcement of regulatory mechanism made all the laboratories in the city to notify all diagnosed TB cases and improve quality and access to testing for TB and drug resistance.

Access to quality treatment and extension of treatment services and support was initiated through: 1) enhanced Public Private Mix (PPM), 2) insourcing of expertise, 3) linkages of infrastructure in one district with expertise in the other, 4) outsourcing of treatment services, 5) co-location of rapid diagnostics and treatment services and 6) supervision of facilities

The municipal corporation trained the administrators and engineers from public work department to take up measures for infection control in public health facilities.

Eminent civil society members and Bollywood movie stars were roped in to mobilize the city to fight against TB. Nutritional support to TB patients has been initiated through innovative fund raising mechanisms.

In recent years, Mumbai expanded diagnostic and treatment capacity by manifold. The number of laboratories for testing drug resistance increased from 1 to 12 and new rapid molecular diagnostic technology was introduced. The number of inpatient MDR-TB designated beds for treatment initiation increased from 22 to 310. Private sector clinics and laboratories joined the public sector in providing quality care to patients. In 2013 there was an 8-fold increase in patients accessing drug resistant TB treatment when compared to 2011.

The city is committed to further improve access to TB patients in a mission mode. This experience could be a pathfinder for addressing other social and health issues in the city.