Tuberculosis treatment centres across the country are facing an acute shortage of reagent to carry out diagnosis, largely due to the apathy of concerned government agencies.

The National Tuberculosis Center, under the Department of Health Services, which is responsible for ensuring that testing kits called ‘Genexpert test cartridges’ are available in all centres, confirmed to the Post that there is a shortage of reagent.

“We have requested the Global Fund to provide 10,000 Genexpert test cartridges immediately,” Anil Thapa, chief of monitoring, evaluation, surveillance and research section at the centre, told the Post. “We had to place the request with Global Fund, as the regular procurement process takes a lot of time.”

Genexpert test is a molecular test that detects the presence of tuberculosis (or TB) bacteria and even identifies its type. It also helps ensure if the TB drugs are working properly against the disease.

Thapa said TB centres started using the Genexpert test cartridges after the World Health Organization changed the algorithm for laboratory diagnosis and treatment of TB. As per the new treatment protocol prescribed by the UN health agency, 120,000 cartridges are needed for a year to provide services to TB patients in Nepal. The TB centre in Kathmandu bought 30,000 cartridges and the Global Fund provided 20,000 more—a total of 50,000. Since the new protocol suggests more tests, the country would face a tough time, say experts.

Thapa blames the Global Fund for the delay in supplying cartridges, saying, “The Fund officials in Nepal had committed to supplying the cartridges at the earliest.”

A Global Fund official in Nepal, however, says it had already supplied 20,000 cartridges—the amount it had committed.

“The problem has arisen not because we failed to ensure the supply; the TB centre did not buy cartridges as per the need,” says the official on condition of anonymity because he was not allowed to speak to the media.

According to the official, representatives from the Fund had last week met with the Center’s officials and expressed their readiness to supply additional cartridges. “We had even requested them VAT waiver and other customs charges,” the official told the Post over the phone.

“We have bought additional 20,000 cartridges from the unspent budget of the current fiscal year but we are unable to import them due to tax and VAT issues,” the official said.

According to the official, the Finance Ministry gives tax and VAT waiver if a particular programme is mentioned in the red book but it does not provide an additional waiver if more amount is required.

Thapa, however, said that the Ministry of Finance would ensure tax and VAT waiver if officials from the National TB centre could explain the seriousness of the need of the cartridges.

TB is a major public health problem in the country which kills 5,000 to 7,000 people every year, according to the Ministry of Health and Population.

There are only 56 tuberculosis centres in the country that provide Genexpert test services. Over 4,000 health care centres—including hospitals, primary health care centers, health posts and private health care centres—provide free treatment for TB. It is estimated that some 44,000 people get infected with the disease every year in Nepal.