What are the various programmes initiated by government to control tuberculosis?

To control the spread of tuberculosis, National Tuberculosis Programme was launched in 1962.

ts long term objective was to reduce TB in the community to that level when it ceases to be a public health problem. Where as its short term objective was to detect maximum number of TB cases, to vaccinate newborns with BCG and to undertake corrective step in an integrated manner through all existing health institutions in country.

The National Tuberculosis Programme is a centrally sponsored programme with the centre providing 50% of the funds in the form of drugs and other equipment and is integrated with general health services through the District Tuberculosis Programme. This Tuberculosis Programme is implemented through District Tuberculosis centre and several peripheral health institutions.

The National Tuberculosis Programme which operates through district tuberculosis programme is the backbone of NTP. Under the programme over 600 TB clinics have been set up all over country of which more than 390 have been regarded as district TB centre which is the nucleus of district tuberculosis programme. The functions of District Tuberculosis Centers are to plan, organize and implement the DTP.

The activities of DTC include:

Active case finding where case finding was taken to the doorsteps of all symptomic patients. Under the programme treatment is free and is offered on domiciliary basis. Anti-tuberculosis drugs for free treatment are supplied by the state government on a 50:50 sharing basis between states and centre. The World Health Organisation has also announced a new treatment and management regiment which is known as Directly Observed Treatment.

This is a short course for the control of tuberculosis and for reducing the threat of multidrug-resistant strains. The DOT strategy involves identifying the sick, infectious T.B. patients, counseling and observing the patients under medication for two months. Under the Strategy the correct combination and dosage of anti-

TB medicines known as short course chemotherapy is also used for the right length of time.

In spite of over two decades programme, it could not achieve much in improving the TB situation in the country. Some of the reasons being poor programme leadership, faulty implementation, misplaced priorities, non availability of drug supply and ignorance on the part of the patients regarding the nature and treatment of the disease also added to the problems.

To overcome this problem, the government of India, World Health Organisation and World Bank together reviewed the Natural Tuberculosis Programme in 1992. Based on the various findings a revised strategy for TB control was evolved which named as revised National TB control programme. Activities under RNTCP included.

(i) Programme will initially begin in health institutions having X-ray units and then it will expand to other centers.

(ii) Supervision and monitoring will be strengthened under the project.

(iii) Drugs will be administered under directly observed therapy short term (DOTS)

(iv) Argumentation of case finding activities through sputum microscopy to detect at least 70% cases.

(v) Involvement of NGOs, Information, education, communication and improved operational research.

Apart from these programmes in August 2007 a DOTS plug programme has been initiated to diagnose and treat the spread of multi-drug resistant tuberculosis caused by a bacterial strain that is resistant to at least two of the best first line drug. Presently a multipronged strategy is imperative to tackle to Multi-Drug Resistance case of Tuberculosis.