Tuberculosis kills 121 a day: No success even after 3 decades of effort

Despite receiving a huge amount of foreign funds and technical assistance over three decades, there has been little success in controlling tuberculosis (TB) in Bangladesh. The Directorate General of Health Services (DGHS) has urgently sought financial assistance from donors to purchase medicines and testing kits.

Experts say the lack of government oversight, overdependence on NGOs, and pressure to meet targets have made the TB control programme corrupt.

A Prothom Alo investigation found that the government and the DGHS have very little control over the National Tuberculosis Control Programme (NTP). Though it is a national programme, NGOs mainly run the frontline operations.

In some districts, the reason behind the rise in cases is not known. Meanwhile, even after finding damaged medicines at the upazila level, the DGHS has not conducted any investigation. Experts believe that the National Tuberculosis Control Programme is operating without proper supervision.

The NTP had been operating for almost three decades under the operational plan (OP) of the Health, Population, and Nutrition Sector Programme (HPNSP). It was found that line directors were appointed for short periods — often replaced before they could fully understand the programme.

In July this year, the government abolished the sector programme. TB is now under the Mycobacterial Disease Control (MBDC) programme. The new MBDC director, Ali Habib, took charge a month and a half ago and will retire in three months. The government will then appoint a new director.

In the second week of October, Ali Habib told this reporter at his office that he was new to the position and had limited understanding of the TB situation or the programme. He suggested contacting him later. When contacted by phone on 1 November, he advised calling again on 2 November. There was no further communication.

Why the concern remains
According to government documents, Bangladesh is among the ten countries with the highest number of TB patients. Since the World Health Organisation (WHO) declared TB a global emergency in 1993, the health sector has been working with NGOs to control it. TB diagnosis, treatment, and medicines are all provided free of cost. Yet, the TB situation has not improved.

Government data show that about 379,000 people are newly infected with TB every year, and 44,000 die annually. That means every day, 1,038 new patients are added, and 121 people die, far more than daily deaths from maternal mortality, road accidents, or suicide.

As elsewhere in the world, the number of drug-resistant TB patients is increasing in Bangladesh. TB bacteria become drug-resistant when medicine quality is poor, treatment is not taken regularly, or the full course of medicine is not completed.

In that case, regular drugs no longer work,  this is called multidrug-resistant TB (MDR-TB). MDR-TB patients spread bacteria directly. According to WHO estimates, around 5,000 people are newly infected with MDR-TB every year in Bangladesh, but only half are detected. This means many people are unknowingly spreading the drug-resistant bacteria.

At the UN High-Level Meeting on TB held in 2023, heads of member states pledged to build a TB-free world by 2035. Several government officials, NGO workers, and representatives of international organizations told Prothom Alo that Bangladesh is not on track to meet the key targets related to TB.

Medicine and kit shortage
DGHS officials said that in any health program, the government usually keeps at least six months’ stock of medicines to ensure supply security. The same practice was followed for TB medicines. However, delays in taking proper measures have led to shortages. At least two to three official letters confirm this crisis.

Former NTP line director Zubaida Nasreen, in a letter to Stop TB Partnership Executive Director Lucica Ditiu on 25 July, wrote that the first-line TB drugs would run out by May 2026. She urgently sought USD 6.5 million in assistance to procure medicines. She also mentioned that TB testing kits would run out by December this year, requiring an additional USD 10.3 million. She sought more funds for other needs as well.

Later, on 12 August, Central Medical Stores Depot (CMSD) Director Md Hujur Ali wrote to the Secretary of the Health Services Division, requesting administrative approval to procure kits worth Tk 2.37 billion.

A representative of a donor organisation, seeking anonymity, told Prothom Alo that the health ministry had returned unused funds this year. “They could not spend the donor money, and now they are again writing for funds. Either there’s a flaw in planning, or a lack of sincerity. Otherwise, why would there be such an emergency situation for TB drugs and kits?” he said.

Corruption driven by target pressure
Targets are set for every step of TB control, identifying TB patients, identifying MDR-TB patients, and ensuring treatment for identified cases. For example, if 379,000 new patients appear annually, the target is to detect 90 per cent of them, or 341,100 patients. This identification work is done mainly by field-level NGO workers, who are given fixed targets. Progress reports are generated every four months.

There are allegations that pressure to meet these targets leads to manipulation of patient numbers. People without TB are sometimes shown as TB patients, or even fictitious persons are listed as patients. This allegation is old but persists.

Dr. Al Amin Sarwar, medical officer at the Faridpur Civil Surgeon’s office, told Prothom Alo that in 2023, 1,813 patients were identified in Faridpur district. In 2024, the number rose to 2,759, and by 25 October, 2025, it stood at 3,082, a 70 per cent increase compared to 2023. This rise is unusual, he said.

A TB analyst, speaking anonymously, told Prothom Alo that since 2023, the number of TB cases has increased abnormally in districts like Faridpur, Madaripur, and Gopalganj, with no epidemiological explanation.

Researchers found that samples from one MDR-TB patient were sometimes used for multiple people, meaning that several healthy individuals were falsely shown as MDR-TB patients. One reason was to increase the count of MDR-TB detections.

The study was published in 2015 in the International Journal of Tuberculosis and Lung Disease. It said donors pressure the programme to meet targets, and as a result, both the NTP and implementing organisations often report inflated figures.

The researchers concluded that target-driven pressure can foster corruption. The estimated number of MDR-TB patients in the country is 5,000, but fewer than 2,000 are detected. Donors push for higher numbers. One of the researchers was from BRAC.

The tendency to inflate numbers still exists. In August and September this year, the Infectious Diseases Division of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), re-tested samples from 84 MDR-TB patients identified by NTP and its partner laboratories. The re-test used Targeted Next Generation Sequencing (TNGS), the most advanced TB diagnostic technology, available only at icddr,b, with support from the US government.

Re-testing found that 11 out of the 84 (13.1 per cent) had no drug-resistant TB bacteria, meaning their diagnoses were incorrect.

Sayera Banu, head of icddr,b’s Infectious Diseases Division, told Prothom Alo that the US government has provided this modern technology to help Bangladesh control TB. “It should be fully utilised for accurate diagnosis and to reduce the risk of mistreatment,” she said. “All MDR-TB samples can be re-tested at icddr,b free of cost.”

Re-testing was made mandatory in February 2024 to ensure accuracy and avoid unnecessary treatment. However, in April this year, the DGHS decided that re-testing of MDR-TB cases was no longer necessary. Many believe donors influenced this decision.

Drugs went bad, no investigation
All TB medicines and medical supplies are stored in a poorly maintained, damp warehouse. Even a light rain floods the premises, and during monsoon, pumps are used to remove water.

When Prothom Alo visited the NTP warehouse in Shyamoli on 30 October, water was seen in several places, enough to submerge shoes. Staff said that ahead of a planned visit by Global Fund representatives in early November, the warehouse had been cleaned and the water removed.

The officer in charge of the warehouse said, “It always floods during monsoon. We don’t have enough manpower to clean or organise the supplies. I even paid from my own pocket to drain the water.”

This central warehouse supplies tuberculosis (TB) medicines, diagnostic kits, and related materials to all districts across the country. However, reports have emerged that several upazilas have returned TB medicines to the warehouse after discovering that the foil packaging was torn.

When asked about this, the warehouse officer said, “That happened some time ago. A few upazilas did return medicines, but there are no such complaints now.”

Spoiled medicines are dangerous. If TB drugs lose their potency, they not only fail to cure patients but also increase the risk of drug-resistant TB. According to multiple sources, the National Tuberculosis Control Programme (NTP) attempted to cover up the issue. No investigation was conducted, and it remains unclear how many upazilas received damaged medicines.

Expert advice ignored
The latest Joint Monitoring Mission (JMM) report warned that Bangladesh is not on track to meet its 2030 targets for reducing TB incidence and deaths. To reach those goals, annual infections must fall to 70,000 and deaths to 6,000.

Respiratory disease specialist and Sushasther Bangladesh (Healthy Bangladesh) president Kazi Saifuddin Bennur told Prothom Alo that the NTP has been excessively bureaucratic since its inception and has failed to ensure coordination between physicians and service providers. “The programme has shown little interest in research or problem-solving. As a result, TB detection in Bangladesh remains below international standards, and in reality, the national programme operates without meaningful oversight,” he said.