Few countries offer richerdiversity than India. Today,its many towns and citiescrackle to the noise of commerce andconstruction the vivid reality of theeconomic growth that continues tocourse across its 29 states and sevenunion territories. But for every newskyscraper and state-of-the-art metrosystem, there remain stark remindersof more work to be done.

Day-to-day issues such asrising food in ation and a stallingmanufacturing sector aside, the slumsthat scar urban neighborhoods, forexample, are perhaps the most visiblesign that far too many citizens are yetto bene t from higher standards ofhousing and sanitation. With this inmind, it is perhaps not surprising thatIndia has yet to eliminate the shadowof tuberculosis (TB) from its shores anything but.

TB is a potentially fatal illnesscaused by airborne bacteria andwhich primarily affects the lungs.India suffers from the highest numberof cases globally some 2.2 millionannually, which is approximately20% of the global total. Althoughmost people do not develop apparentsymptoms, some develop active TB,which is contagious. Currently, morethan nine million people develop activeTB each year, and 1.7 million peopledie from this disease. Co-infectionwith TB and HIV (TB/HIV) and a surgein multi-drug-resistant TB (MDR-TB),a strain of bacteria that is resistantto at least two rst-line TB drugs, arethreatening to disrupt recent globalsuccesses in TB control, as there islittle effective treatment available forthese forms of TB.

An estimated 5,000people every daydevelop the disease,but diagnosis is rarelystraightforward. TheTB care lifecyclespans several phases,beginning with multiplechannels of identifyinga suspect, followedby diagnosis of TB byconducting appropriatelab tests and thentreatment adherenceand monitoring. Eachphase involves multiplestakeholders, acrosspublic and privatesectors, which coexist ina dynamic environment.This means that apatient may visitmultiple providersor chemists before acorrect diagnosis ismade and appropriatetreatment is provided.On top of that, patientsshould continue thetreatment regimen for aperiod of six months, whichneeds to be monitoredclosely to guard against therisk of MDR-TB. To avoida potential epidemic, theneed to actively address the underlyingissues becomes ever more critical. Sowhats to be done?

A time for teamworkThe Bill and Melinda Gates Foundation(BMGF), which works with organizationsworldwide to tackle critical problems inglobal development, global health, and

global policy and advocacy, has beenworking actively toward eradicating TB inIndia for the past decade. Its focus is tosupport Government of Indias RevisedNational TB Control Program, which isprioritizing the introduction of ICT foreffective implementation, service deliveryand monitoring of TB control processes atthe grassroots.

Millions of people in India andaround the world are continuing tosuffer from this life-threatening illness,and the clock is ticking.

Continuing our series about how weare helping build a better workingworld, EYs Guru Malladi,Vibhor Jain and T. Koshy explainhow we are working with the Billand Melinda Gates Foundationto address the spread of tuberculosisin India.TB

Indiastreatmenttable

27November 2014Citizen Today

Building a better working world

Emerging challenges, emerging solutions

Ours is a world of contrasts, one where growth is increasing indeveloping and high-income economies while more than 1 billionpeople still live in extreme poverty. Globalization, demographicshifts and urbanization are reshaping 21st century government,no more so than in India. I was born in Delhi and every time I returnI am struck by how much it is changing in terms of new buildingsand infrastructure but also by the poverty that still exists withinits borders.

That such diversity still exists in one of Indias richest citiesreminds us of the work still to be done, and why building a betterworking world is EYs purpose. Our work on TB control in India bringing together stakeholders and embracing the potential oftechnology to implement sustainable and transformational change is just one example of how we help governments navigate thisfast-changing environment and emerge with economies enhanced,communities strengthened and a better working world for all.

Rohan Malik is EYs Emerging Markets Leader,Government & Public Sectorrohan.malik@in.ey.com@rohanmalik_EY

Guru Malladi is EYs Government AdvisoryServices Leader in Indiaguru.malladi@in.ey.com

Vibhor Jain is a Senior Manager with EYsBusiness Advisory Services in Indiavibhor.jain@in.ey.com

T. Koshy is a Government Advisory ServicesPartner with Ernst & Young Pvt. Ltd in Indiat.koshy@in.ey.com

In 2012, BMGF completed a landscape analysis ofTB in India and identi ed leading ICT practices for thepurpose of disease control. Subsequently, EYs teamshave collaborated with the foundation and its partners onseveral TB control projects. During the course of theseassignments, we have engaged with key stakeholdersand supported efforts to modernize TB care in India.EY now has a comprehensive understanding of thechallenges faced for TB control in India, and the potentialsolutions that can be deployed through collaboration withpolicymakers, funding agencies and public and privateproviders. We have also developed an ICT frameworkthat delivers better visibility and data sharing amongstakeholders in the TB care ecosystem.

Testing the watersEY is currently working with BMGF on an urban TB projectwhich aims to utilize the potential of an ICT applicationand a contact center to promote participation from theprivate sector to help control the spread of TB. Theprogram, which will be implemented over a period of twoyears in the three cities of Mumbai, Patna and Mehsana,will lead to improved visibility and control in enablingtimely suspect identi cation and diagnosis, as well asmore effective patient tracking. The contact center willbe leveraged for provision of free drugs to patients in theprivate sector through an e-voucher mechanism withina collaborative network of providers, labs, chemists,and patients. The same contact center is expected tobe the critical component in treatment adherence atan individual patient level. A further bene t is that theproject is highly replicable, offering a model for privatesector engagement across the country.EYs role is to manage the implementation and usageof the ICT platform across the entire program. ICT isexpected to play an instrumental role in connectingmultiple stakeholders under a common framework for anumber of related purposes. These include sharing dataincreased information visibility, monitoring the ef cacyof the private provider interface agencies in Mumbaiand Patna, early diagnosis, free drugs provision andeffective tracking and increased probability of treatmentadherence. To this end, the EY team has undertakenmultiple eld visits to understand the current on-the-ground processes being followed in the TB care systemand has studied the success rates of different ICT systemsdeveloped in the past. With the knowledge of the on- eldrequirements and these ICT systems, EY has accumulateddeep insights to help develop and operationalize a newICT architecture for the project.

Looking forwardSigni cant progress has been made over the past two decades between 1990 and 2012 the TB mortality worldwide fell by 45%.However, the prevalence of the disease in India underlines the scale ofthe task ahead. The fact remains that millions of people in India andaround the world are continuing to suffer from this life-threateningillness and the clock is ticking. While clinical researchcontinues into a new vaccine and better drugs, effective monitoringtools such as the contact center we are currently focusing on are ofhuge importance. The EY team is proud to help accelerate the adoptionof new approaches to ghting TB but, in this case anyway, we lookforward to the day when our work will no longer be required.

Indias TB treatment table