The Revised National TB Control Programme
- The Revised National TB Control Programme (RNTCP) thus formulated, adopted the internationally recommended Directly Observed Treatment Short-course (DOTS) strategy, as the most systematic and cost-effective approach for TB control in India. Political and administrative commitment, to ensure the provision of organised and comprehensive TB control services was obtained. Adoption of smear microscopy for reliable and early diagnosis was introduced in the general health services. DOTS was adopted as a strategy for provision of treatment to increase the treatment completion rates.
- The supply of drugs was also strengthened to meet the requirements of the system.
- The key objectives of the RNTCP were to achieve and maintain at least 85 per cent cure rate among the new smear-positive cases initiated on treatment, and thereafter a case detection rate of at least 70 per cent of such cases
RNTCP (Revised National TB Control Programme Growth) & Innovations:
- The RNTCP built on the infrastructure and systems built through the NTP. A key focus area was strengthening the recording and reporting systems.
- An addition to the RNTCP was the establishment of a subdistrict supervisory unit, known as a TU (Tuberculosis Unit), with dedicated RNTCP supervisors. This led to decentralization of both diagnostic and treatment services, with treatment given under the support of DOT providers.
- The quality of diagnosis of TB patients under RNTCP improved by giving the highest priority to the provision of quality assured sputum smear microscopy services.
- Another key innovation under RNTCP has been the development of Patient-Wise Boxes, which contain the full course of treatment for an individual patient.
- This ensures that treatment of that patient cannot be interrupted due to a lack of drugs. The RNTCP has effectively decentralized supervision via the sub-district TB Units, with in-built systems for monitoring and evaluation.
RNTCP (The Revised National TB Control Programme) II
- RNTCP II was developed based on the lessons learnt from the implementation of the programme over a 12-year period (1993-2005).
- RNTCP II was designed to consolidate the gains achieved in RNTCP I and to initiate services to address TB/HIV, MDR-TB and extend RNTCP to private sector.
- Systematic research and evidence building to inform the programme for better design was also an important component of the programme. The emerging needs of Advocacy, Communication and Social Mobilization were addressed in the new phase.
- The challenges imposed by the structures under NRHM were also taken into account for RNTCP II.
- Since 2007, the programme has been consistently achieving a treatment success rate of >85% and a NSP case detection rate (CDR) of >70%.
- In 2011, RNTCP achieved the NSP CDR of 72% and treatment success rate of 88%, which is in line with the global targets for TB control.
Monitoring, supervision and evaluation:
- The RNTCP’s ‘Supervision and Monitoring strategy’ includes detailed guidelines, tools and indicators for monitoring the performance from the PHI level to the national level.
- The quality programme implementation is ensured by frequent Internal and external evaluations.
- The programme is focusing on the reduction in the default rates among all new and re-treatment cases.
- Quality assured sputum smear microscopy facilities are available nationwide through about 13,000 sputum microscopy laboratories in the health system.
- As a result, chest symptomatic examined has increased from 397 to 642 per 100,000 population per annum over the last 10 years.
- Quality assured anti-TB drugs for the full course of treatment are provided to the patients through patient wise boxes.
- Decentralized treatment is provided through a network of more than 6,40,000 DOTS providers, to provide treatment to the patients as near to their home as possible