East Khasi Hills District TB Control Society Headquarter-Shillong

TB Facts: 
·        Each year, nearly 2 million people in India develop TB and over 450,000 die from it.
·        TB each a major barrier to economic development, costing India Rs.12,000 crore (US $ 3 billion) a year.
·        Directly observed treatment, short-course (DOTS) is the most cost effective health intervention available for TB control.

Social & Economic Burden:

      ·        TB kills more women than all causes of maternal mortality combined
·        More than 100,000 women are rejected by their families on account of TB
·        More than 300,000 children leave school to work as a result of parental TB
·        Social stigma is a major concern to women with TB in India as they often lose their status as a wife or mother
·        TB in the family also has serious implications for children
·        100 million productive work days lost due to TB

SUMMARY OF THE REVISED NATIONAL TUBERCULOSIS CONTROL PROGRAMME

The Revised National Tuberculosis Control Programme (RNTCP) with Directly Observed Treatment Short-course (DOTS) strategy was begun on a pilot basis in 1993 with the help of WHO in five selected states in India covering a population of 2.35 millions. The expansion of the programme started in 1998. By June 2002, 49 percent of the population had access to high quality TB treatment. Owing to this rapid expansion, India now has the distinction of having the second largest health programme of this kind in the world after China. Along with the rapid expansion, it has sustained the excellent results. The diagnosis of cases through sputum examination has been given adequate emphasis. This aspect is reflected in the ratio of smear positive to smear negative cases in RNTCP, which was approximately 1:1. Under the DOTS strategy, more than 80% of patients have been successfully treated. Most notably, death rates among diagnosed TB case have dropped substantially compared to earlier programme. The challenge is to maintain the quality on the one hand, and on the other hand to continue the expansion of the programme to the remaining population and to improve the case finding from the current rate of 50-60% to at least 70%.

In spite of the implementation of National Tuberculosis Programme (NTP) since 1962, no significant epidemiological impact on disease situation has been observed. Every year, more than 2 million new cases are added and nearly 5000,000 TB deaths occur. TB remains by far, the leading infectious cause of death in the country. The emergence and spread of HIV and drug resistant TB threatens to further complicate the TB situation. In the year 1992, the Government of India together with the World Health Organization (WHO) and Swedish International Development Agency (SIDA) reviewed the NTP in depth.  The review brought out certain inadequacies in the programme, mainly on the methodology of diagnosis of cases as well as completion of treatment. The Revised National Tuberculosis Programme (RNTCP) was accordingly designed with a new management strategy in consultation with State governments and World Banks. It is based largely on research done in India in the field of TB over the past 40 years. The goal of RNTCP is to cure more than 85% of new sputum smear positive pulmonary TB patients and to achieve at least 70% detection of such cases. The RNTCP strategy shifts the responsibility of cure from the patient to the health system.