The large scale implementation of the Indian government’s Revised National TB Control Program (RNTCP) (sometimes known as RNTCP 1) was started in 1997. The RNTCP was then expanded across India until the entire nation was covered by the RNTCP in March 2006. At this time the RNTCP also became known as RNTCP II. RNTCP II was designed to consolidate the gains achieved in RNTCP I, and to initiate services to address TB/HIV, MDR-TB and to extend RNTCP to the private sector. RNTCP uses the World Health Organisation (WHO) recommended Directly Observed Treatment Short Course (DOTS) strategy and reaches over a billion people in 632 districts/reporting units.
With the RNTCP both diagnosis and treatment of TB are free. There is also, at least in theory, no waiting period for patients seeking treatment and TB drugs.
The initial objectives of the RNTCP in India were:
New sputum positive patients are those people who have never received TB treatment before, or who have taken TB drugs for less than a month. They have also had a positive result to a sputum test, which diagnoses them as having TB.1Mukherjee, A “Outcomes of different subgroups of smear-positive retreatment patients under RNTCP in rural West Bengal, India”, Rural and Remote Health www.ncbi.nlm.nih.gov/pubmed/19260766
The work required by the RNTCP is set out by the Government of India in the National Strategic Plan 2012 – 2017. In addition to implementing the NSP 2012 – 2017, the Government of India had also in 2014 agreed the Standards for TB Care in India, which sets out the standard of TB treatment in India and TB testing & diagnosis in India that should be provided by the RNTCP in all parts of India.2Standards for TB care in India www.searo.who.int/india/publications/en/ This has subsequently been endorsed by the Ministry of Health and Family Welfare. Among other points this acknowledged that patients would be treated by private providers, rather than simply demanding that unwilling patients should be referred to the public sector.
The Government of India had also in 2014 adopted, with all Member States of the WHO, the End TB Strategy. The End TB strategy, together with these other initiatives, effectively called for a major transformation of India’s current approach to tackling TB.
The Joint TB Monitoring mission (JMM) of the RNTCP brought together a number of national and international experts and organisations in 2014, to generally review the progress, challenges, plans and efforts of the RNCTP to control TB. The implementation of the NSP 2012 – 2017 was one of the areas looked at.
The JMM acknowledged India’s remarkable achievements in TB control over the previous ten years. This included testing more than 80 million people, detecting and treating 15 million TB patients, and saving millions of lives as a result of the efforts of the RNTCP. However, they also said that overall:
“the implementation of the NSP for 2012 – 2017 is generally not on track: projected increases in case detection by the RNTCP have not occurred, vital procurements are delayed and many planned activities have not been implemented. Also, of the recommendations made by the JMM 2012, about two thirds have not been fully implemented.”
The very extensive JMM report highlighted a number of problems with the work of the RNTCP. These included:3Leaked: draft 2015 report on Indian Revised National TB Control Programme from Joint Monitoring Mission www.tbonline.info/posts/2015/7/23/leaked-draft-2015-report-indian-revised-national-t/
The report gives extensive recommendations for each part of the report, and these include:
The overall budget required in 2012 – 2017 to achieve the Universal Access vision, to save 750,000 lives from TB, and to control MDRT TB, was estimated to be Rs. 5825 crore ($1.17 billion) over the period 2012 – 2017. However, the Planning Commission of India has so far only approved Rs. 4500 crore ($900 million). These budget cuts have been widely criticised and in January 2015 a warning letter was submitted to the government signed by TB officers of all states and Union territories. One doctor said:
“There is always a shortage of TB drugs, lack of labs, slow diagnostic tools, inadequate management of treatment and lack of trained personnel. Moreover, since we have failed to give the existing staff their salary dues they are demoralised”4Srivastava, K, “TB epidemic looms large with Rs 2,000 crore fund cut, erred policy”, dna, 10 January, 2015 www.dnaindia.com/
You can read more about TB in India.
Draft 2015 report on Indian Revised National TB Control Programme from Joint Monitoring Mission www.tbonline.info/media/uploads/documents/jmmdraft2015.pdf
Revised National Tuberculosis Control Programme Guidelines on Programmatic Management of Drug Resistant TB (PMDT) in India www.tbcindia.nic.in
Revised National Tuberculosis Control Programme National Strategic Plan 2012-2017
Standards for TB Care in India www.tbcindia.nic.in
TB India 2015 Revised National TB Control Programme Annual Status Report, New Delhi, 2015 www.tbcindia.nic.in
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|1.||↑||Mukherjee, A “Outcomes of different subgroups of smear-positive retreatment patients under RNTCP in rural West Bengal, India”, Rural and Remote Health www.ncbi.nlm.nih.gov/pubmed/19260766|
|2.||↑||Standards for TB care in India www.searo.who.int/india/publications/en/|
|3.||↑||Leaked: draft 2015 report on Indian Revised National TB Control Programme from Joint Monitoring Mission www.tbonline.info/posts/2015/7/23/leaked-draft-2015-report-indian-revised-national-t/|
|4.||↑||Srivastava, K, “TB epidemic looms large with Rs 2,000 crore fund cut, erred policy”, dna, 10 January, 2015 www.dnaindia.com/|