Dr. Ravi D'Souza
The National Tuberculosis Programme (NTP) was established in the year 1962 with the immediate objectives of detecting tuberculosis (TB) cases among patients attending health institutions, to vaccinate infants with BCG, both in the existing health institutions in the country. The long term objectives were to reduce TB in the community to a level where it ceased to be a public health problem.
In 1992, the NTP was reviewed by the Govt. of India (GOI), the World Bank and the World Health Organization (WHO). The NTP was renamed as the Revised National Tuberculosis Control Programme (RNTCP) and implemented in a phase-wise manner, with revised strategies for the programme. These were:
- Improvement in the cure rate of infectious cases of TB (to 85%) through the DOTS method using health workers to actually administer the drugs themselves to the patients.
- Case finding to be strengthened by improved sputum microscopy to detect atleast 70% of estimated cases.
- Involvement of NGOs, and strengthening of IEC activities.
In the year 2006, the RNTCP covered the whole country. Currently, the programme detects 1.5 million new cases every year and treats them in 400,000 DOTS centres. 13,000 Designated Microscopy Centres (DMC) provide the necessary diagnostic support for sputum examination.
WHO – GOI Joint Monitoring Mission (JMM)
This review of the RNTCP was held between the 10th and the 23rd of April 2015. It was the fifth such exercise, which is conducted every 3 years. The review was conducted in two districts each of the states of Gujarat, Madhya Pradesh, Himachal Pradesh, Andhra Pradesh, Odisha, Meghalaya and Tripura.
The JMM was a meticulously planned exercise, and probably the single largest review and evaluation of a national disease control programme anywhere in the world.
The following aspects of the RNTCP were evaluated:
- Targeted interventions for special groups
- Drug Resistance
- Human Resources
- Paediatric TB
- Drug Procurement and Supply Chain Management
- Diagnosis (newer methods) and case finding
- Support to patient, families and social protection
- Community Engagement; Advocacy, Communication and Social Mobilization (ACSM)
About 120 national and international experts were assembled for the review. This group comprised clinicians, public health specialists, pharmacists, teaching faculty from medical colleges, activists, epidemiologists, communication professionals, etc.
After an initial briefing in New Delhi, teams of 12 to 15 persons from the larger group left for the capital of each state. Here they received a briefing about the RNTCP in the state from senior officials of the Health & Family Welfare Department, including the State Tuberculosis Officer, the Health Secretary and the Director of Health Services.
Each state group then split up to visit two different districts. Here they were briefed about the RNTCP in the district. The members of the district groups visited different health institutions including the District TB Centre and Primary Health Centres. Other institutions like the district jail and schools were also visited. To interact with the community, some members spent time in villages with different groups like women, youth, self-help groups etc.
At the state level, some other institutions like the drug supply stores, medical college hospitals and research institutions were also visited by different members of the state-level teams.
Before leaving the state, a debriefing session was conducted with the same state Govt. officials and the observations and findings of the team members were presented to them.
After returning to New Delhi, each state team presented the findings of their visit to the larger group. The final report of the JMM was then compiled. This is being submitted to the GOI for final approval before being made available to the public.
At a personal level, the WHO – JMM was an extremely interesting and useful exercise for me. Apart from being an occasion to interact with leading national and international experts on different aspects of TB, it was also an opportunity to get acquainted with the latest developments in the control of this important disease. I was in the team that visited Odisha, which was familiar ground for me – I have lived and worked for 11 years in that state. Hence I had no problem interacting with the community as I spoke to them in Odiya, much to the surprise of my fellow team members and local officials.