Department of Health
NATIONAL TB CONTROL PROGRAMME
4.8. National TB Control Programme
4.8.1. Problem: In India 14 million people are estimated to be suffering
from active tuberculosis of which 3-3.5 million are highly infectious. About
0.5 million die of the disease every year. An estimated 2-2.5 million cases are
added every year.
4.8.2. Programme: The Programme is in operation since 1962 and is integrated
with General Health Services. This Programme aims to detect cases early and
treat them effectively till they are cured. In the district, the programme is
implemented through the District Tuberculosis Centre (DTC) and a number of Peripheral
Health Institutes (PHIs). The District Tuberculosis Programme (DTP) is
supported by State Level Organisation for coordination of the tuberculosis
activities in the State and supervision of the DTPs. The programme provides
free service to the community. Now., it has been decided to provide 100%
requirement of anti-TB drugs from Central government. All drug will continue to
be available free of cost.
4.8.3. Achievement: At present 446 DTCs have been established out of which
292 are short course chemotheropy districts. A team of medical and para medical
personnel duly trained at NTI Bangalore are available at these Centres. There
are 47,600 TB beds in the country and 330 TB clinics are functioning in urban
areas. In addition, there are 17 State TB Training and Demonstration Centres.
4.8.3.(i) National TB Control Programme has been accorded high priority by
the government with inclusion of NTP in the 20 point Programme. A thrust has
been given for the expansion of the essential activities under the programme.
There has been considerable increase in the budgetary allocation to the
programme e.g. from Rs. 1.80 crore in 1981 the outlay has been increased to
Rs.125.00 crore in 1998-99. Short Course Chemotherapy (SCC) containing more
effective drugs is being introduced in the country in a phased manner.
4.8.3.(ii) Since the introduction of the programme about 1.5 million TB
cases report to the DTP every year. The mortality rate of 80 per one lakh
population in the 70's has been reduced to 53 per one lakh of population in
1993.
4.8.4. Revised National Tuberculosis Control Programme: The NTCP was
reviewed during 1992 by an expert panel. Based on the finding and
recommendations of the expert committee, Government of India evolved the
revised strategy with the objective of curing atleast 85% of smear positive
cases and detecting at least 75% of them. This strategy was pilot tested
initially in 1993 - 94 on a population of 2.35 million and thereafter was
expanded for assessing technical and operational feasibility to 17 project
sites covering a population of 13.85 million.
4.8.4.(i) Encouraged by the results of the pilot studies, Government of
India decided to extend the revised strategy in the country covering in a
phased manner a population of 270.2 million in 102 districts in 15 States with
World Bank assistance. Another 203 SCC districts will be strengthened as a
transitional step for introduction of revised strategy. Out of the estimated
expenditure of Rs. 740.28 crore required for a period of 5 years of the
project, World Bank will contribute US$ 142.4 million.
4.8.4.(ii) In the first year, service delivery of the RNTCP has already
started in all the 39 districts. In addition, 61 SCC districts are being
strengthened by way of providing necessary infrastructure such as Binocular
Microscopes and training as a transitional step to prepare them to adopt RNTCP
at a later stage.
4.8.5. Budget & Expenditure: There has been a considerable increase in
budget allocation as depicted in the table below:
(Rs. in Crore)
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Year Budgetary Actual
Provision Expenditure
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1993-94 37.50 17.19
1994-95 46.00 32.15
1995-96 46.00 39.71
1996-97 27.97 13.63
1997-98 80.00 32.05
1998-99 125.00 NA
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4.8.6. Targets and Achievements: Target for detection of new TB cases &
sputum examination and achievements for the year 1994-95, 1995-96 and 1996-97
are given in the Table next page.
4.8.7. At NTI Bangalore, eight training courses for Medical and Paramedical
staff working in the Programme in various states are held every year for
orienting them in NTCP.
4.8.7.(i) For imparting training on RNTCP, four Central Institutes viz.,
NTI, Bangalore, TRC, Madras, AIIH&PH, Calcutta and LRS Institute of TB
allied diseases have been strengthened.
Table
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Targets Achieve- Percen-
ments tage
1994-95
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Sputum
Examina- 35,18,000 22,41,379 63.70
tion
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New TB
Cases 19,00,000 12,49,139 65.74
Detection
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1995-96
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Sputum
Examina- 39,99,301 24,02,969 60.10
tion
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New TB
Cases 12,70,000 13,89,695 109.00
Detection
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1996-97
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Sputum
Examina- 41,40,801 33,60,000 81.20
tion
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New TB
Cases 13,64,000 14,60,000 107.00
Detection
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1997-98
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Sputum
Examina- 1,41,89,175 43,59,467 30.70
tion
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New TB
Cases 12,77,026 13,09,681 102.00
Detection
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Smear 4,72,973 3,51,921 74.40
positive
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4.8.7.(ii) These Institutes are rendering training to district & State
level officers on RNTCP. 17 State TB and training demonstration centres are
being strengthened under RNTCP so that these Institutes can impart training to
various categories of staff, both in NTCP and RNTCP.
4.8.8. Monitoring & Review: Programme data is generated at the
Peripheral Health Institutions on monthly basis and compiled by the districts
every quarter. National Tuberculosis Institute, Bangalore consolidates the
quarterly reports and analysing them for preparing the annual reports for
submission to the Central TB Division and feed back to districts. The districts
also send monthly information on case-detection, sputum examination and new
sputum positive cases under 20 Point Programme directly to the Central TB
Division. Quarterly reports of 39 RNTCP project sites are being regularly sent
to the Central TB Division of the Directorate General of Health Services for
compilation, annualization and feed back.
4.8.8.(i) The Programme is periodically reviewed by the Ministry of Health
and Family Welfre and the Directorate General of Health Services for
appropriate action. Procurement of anti-TB drugs and expenditure is also
reviewed periodically.
4.8.8.(ii) Annual Review Meetings of the Programme Officers of all states
and Union Territories are held regularly. Meeting of State TB Officers of 1st
year Districts of 15 RNTCP States was held on 15.9.98 to review the progress in
activity undertaken for implementation of RNTCP.
4.8.9. ODA Support: The British ODA (DFID) had reached an agreement with the
Government of India for support to the RNTCP to the extent of $ 900,600. The
areas of support include strengthening of Central TB Division, training
activities and implementation of the Revised NTCP in Medak district of Andhra
Pradesh and Moti Nagar and Nehru Nagar districts of Delhi. ODA (DFID) has also
expressed their willingness to provide support for implementation of RNTCP in
entire State of Andhara Pradesh and the proposal is under consideration of
Government of India.
4.8.10. DANIDA Support: DANIDA assistance has been sought to implement the
revised strategy of NTCP in the State of Orissa. Government of Denmark has
agreed to provide a grant of DICK 54.8 million (approx. Rs. 31.95 crore) for
implementation of Revised NTCP in 14 tribal districts of Orissa.
4.8.10.(i) Under this project the DANIDA assistance is aimed at supporting
the Revised NTCP initially in three districts in Orissa with a population of
approximately 5 million and gradually extending to a total of 14 districts with
a population of 12 million in five years. RNTCP projects will focus
specifically, on patients from the most marginalised groups in Orissa namely
tribal population and schedules castes.
4.8.11. Flow of finds: Funds are being released directly from Central TB
Division to District TB Societies formed.
4.8.11.(i) Under the 9th Plan, the revised Strategy would be expanded in a
phased manner throughout the country.