Revised National Tuberculosis Control Programme

Introduction

The National TB Control Programme was started in 1962 with the aim to detect cases earliest and treat them. In the district, the programme is implemented through the district Tuberculosis Centre (DTC) and the Primary Health Institutions. The District Tuberculosis Programme (DTP) is supported by the state level organization for the coordination and supervision of the programme. The Revised National Tuberculosis Control Programme (RNTCP), based on the Directly Observed Treatment, Short Course (DOTS) strategy, began as a pilot project in 1993 and was launched as a national programme in 1997 but rapid RNTCP expansion began in late 1998. The nation-wide coverage was achieved in 2006.

The Revised National Tuberculosis Control Programme has initiated early and firm steps to its declared objective of Universal access to early quality diagnosis and quality TB care for all TB patients'. RNTCP is being implemented with decentralised services of TB diagnosis through 13,000+ designated microscopy centres and free treatment across the nation through 4 lakh DOT centres.

National Strategic Plan for 2012-17

RNTCP's National Strategic Plan (NSP) 2012-17 was part of the country’s 12th Five year Plan. The theme of the NSP 2012-17 was "Universal Access for quality diagnosis and treatment for all TB patients in the community" with a target of "reaching the unreached". The major focus was early and complete detection of all TB cases in the community, including drug resistant TB and HIV-associated TB, with greater engagement of private sector for improving care to all TB patients. The NSP was backed up by GoI’s commitment for substantial increase in the investment for TB control, with a four-fold increase in budgetary allocation.

During the NSP 2012- 17 period, significant gains were made in strengthening the support structures, programme architecture and implementation environment for TB control. This includes mandatory notification of all TB cases, integration of the programme with the general health services (National Health Mission), expansion of diagnostics services, programmatic management of drug resistant TB (PMDT) service expansion, single window service for TB - HIV cases, national drug resistance surveillance and revision of partnership guidelines.

National Strategic Plan for 2017- 25 for TB elimination in India

The NSP 2017 - 2025 builds on the success and learnings of the last NSP and encapsulates the bold an d innovative steps required to eliminate TB in India by 2030. It is crafted in line with other health sector strategies and global efforts, such as the draft National Health Policy 2015, World Health Organization’s (WHO) End TB Strategy, and the Sustainable Development Goals (SDGs) of the United Nations (UN).

Vision and Goal

Vision : TB - Free India with zero deaths, disease and poverty due to tuberculosis.

Goal : To achieve a rapid decline in burden of TB, morbidity and mortality while working towards elimination of TB in India by 2025.

Results Framework

Results Framework (impact and outcome indicators and targets)

Strategic pillars

The requirements for moving towards TB elimination have been integrated into t he four strategic pillars of "Detect - Treat  - Prevent  - Build" (DTPB).

• Detect : Find all DS - TB and DR - TB cases with an emphasis on reaching TB patients seeking care from private providers and undiagnosed TB in high - risk populations.
• Treat : Initiate and sustain all patients on appropriate anti - TB treatment wherever they seek care, with patient friendly systems and social support.
• Prevent the emergence of TB in susceptible populations
• Build and strengthen enabling policies, empowered institutions and human resources with enhanced capacities.

Action list

For achieving the goals of the NSP 2017 - 2025, the following critical components of the programme will be addressed on priority. The next set of actions include:

• Ministry of Health and Family Welfare (MoHFW) will evolve a scheme to address the patients seeking care in private sector. The scheme will have suitable incentives for the private doctors and patients to report TB cases coupled with another scheme to provide free of cost medicines to TB patients going to a private doctor/institute.
• A robust, modern MIS system will be developed to monitor the newly diagnosed as well as existing cases of TB on delivery of the drug kit to the patient, compliance to treatment regimen etc. The MIS system will have suitable linkages with the private pharmacy on sale of anti-TB drugs thereby integrating those patients into the MIS.
• The availability of rapid molecular tests will be suitably augmented so that these diagnostic facilities are also made available for patients referred by any private doctor or institute.
• To improve the compliance of the TB patients to the treatment regimen, MoHFW will start customized SMS services to the individual patients on regular basis reminding them about the time to consume the drugs.
• The MoHFW will establish mechanisms for facilitating nutritional support to the TB patients, including financial support through DBT mode.
• The MoHFW will work on a scheme to provide suitable incentives to the States doing well in RNTCP. The incentives will also be linked with performance in "Swachh Bharat Mission".
• TB Corpus Fund: To improve financial sustainability in the TB sector the programme will mobilise additional resources to accelerate TB control efforts, for which the 'Bharat Kshay Niyantran Pratishtan' (India TB Control Foundation) is proposed. Activities like nutrition support for TB patients, active case finding in prisons, slums, tribal area, sputum collection and transport in difficult areas will be carried out.

Tracking the progress

A national level annual review of the programme will be undertaken by the TB elimination board chaired by the Prime Minister’s Office (PMO). Apart from the SDG related indicators the review will also track programme performance and provide directives to enhance the ease of programme implementation at all levels.

To access the complete NSP document, click here.

Source: Central TB Division, Directorate General of Health Services, Ministry of Health with Family Welfare