As a young psychiatrist in India, Dr Jamie Tonsing worked in an institution where many patients were also afflicted with tuberculosis, and this brought her into contact with several WHO consultants who had been enlisted to assist in launching the country’s new Revised National TB Control Programme (RNTCP). Based on the new DOTS strategy, the RNCTP began as a pilot in 1993 and, in 10 years, grew to cover 778 million people. In three more years, by World TB Day 2006, the entire country had been covered.
The enormity of India’s TB burden – which remains the highest in the world – combined with the speed of the scale-up and the passionate commitment of those involved created a heady environment that proved irresistible to Tonsing. Before long, she left psychiatry behind to work on the front lines of India's tuberculosis fight with legendary figures, such Dr GR Khatri, then head of the RNTCP, and Dr Thomas R Frieden, a WHO Medical Officer who is today Director of the US Centers for Disease Control and Prevention (CDC).
Since then, tuberculosis has been the focus of Tonsing’s career, which has taken her to The Philippines, where she managed a project for WHO, and to Cambodia, where she worked with Family Health International, as well as to other posts.
When she accepted the position as Director of The Union South-East Asia Office (USEA) in New Delhi late last year, her chosen path brought her back to her native India for the first time in a decade.
There she has found that despite the extraordinary progress made by the RNTCP, tuberculosis is still one of India’s most formidable public health foes. The numbers remain staggering – 1.9 million new cases a year, 1.2 million co-infected with TB and HIV and deeply troubling rates of drug-resistance that contribute to more than 1,000 deaths every day.
“More than a third of the estimated TB cases in India are still unable to access the RNTCP’s services, which amounts to hundreds of thousands of so-called ‘missing cases’, she says. “This is just not acceptable. We can not beat TB this way.”
One positive change she has observed is a great increase in the number of NGOs and other types of organisations involved in TB – and The Union’s own Project Axshya is an outstanding example of this kind of expanded stakeholder network. Led by USEA and 9 partner organisations, the Global Fund-supported Axshya fans out across 300 districts through some 1,500 smaller groups and an army of volunteers to bring TB information and quality services to marginalised and at-risk people. The project has reached 750 million people over the past four years.
“The kind of community engagement and decentralisation that The Union has modeled though Axshya is essential”, says Tonsing. "Before it was just the government and WHO. Now there are many more players, and that is good, because the government can do many things – but it can't do everything".
How to lower India’s incidence rates? How to bring down mortality? These are the questions that Tonsing and her USEA team, as well as stakeholders at every level of society, have dedicated themselves to answer.
“The global TB community has committed to reducing TB deaths by 90 percent by 2035”, says Tonsing. “We want to be at the forefront of showing that India can achieve this. The Union has a strong, experienced team, and we know TB inside out, so given the needed resources and the passion and knowledge that have brought us this far, I believe we will”.