The ‘Computer Janch’ for TB: Rolling Out of Gene Xpert in Nepal
The national average for case finding of Tuberculosis in Nepal has remained between 70-76% for more than a decade now. Nepal Tuberculosis Programme (NTP) has an objective to reach the case finding rate of 82% by 2015 nationally. Accordingly, a new technology in detecting tuberculosis has been introduced in Nepal from 2011 under the TB Reach Programme supported by Canadian International Development Agency to increase early case detection of tuberculosis. So far, sputum microscopy has been used as the basic test to diagnose TB in people based on physician’s recommendation. The new technology, called GeneXpert, endorsed by WHO in 2010, is considered powerful as it is considered to detect the tuberculosis bacteria even in the samples that are not diagnosed as positive from the sputum microscopy. It also determines whether the TB bacterium in the patient is Rifampicin resistant or sensitive, i.e. the test result determines the condition of the TB patient in advance so that they can be put on medication regime accordingly.
Currently, there are 22 GeneXpert machines in Nepal introduced and implemented by the International Organization for Migration, Health Research and Social Development Forum (HERD) and National Tuberculosis Centre (NTC). Introduction and implementation of a particular technology extends beyond the technical milieu of curbing disease, rather is situated in complex socio-economic and political environment and culture of a particular programme and therefore generating questions, like in this case: What does this technology mean in the field of TB diagnostics? How do different actors and stakeholders in the TB control programme come together for the planning and execution of the new technology? How do health workers’ perceive this technology and whether it impacts the relationship between them? What challenges does the introduction of new technology pose to the implementing organization and the National TB programme?
Based on ethnographic observations of the TB labs and interactions with the lab workers and district focal persons of TB [as a part of an ongoing research] in various parts of the country, we aim to chart the process of rolling out of the GeneXpert technology in Nepal along with the intricacies of co-ordination with different actors at multiple levels. The paper while attempting to understand the social life of the GeneXpert technology in Nepal, will highlight the issues and challenges around introducing the new technology, perception of the lab workers and its impact on the relationship among the health workers and also on the National Tuberculosis Programme.