Some important facts that need attention for success of RNTCP
Nair, S.S. (2006) Some important facts that need attention for success of RNTCP. Not intended for publication, Bangalore, India.
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National Tuberculosis Programme (NTP) was formulated on the basis of operations research by National Tuberculosis Institute, Bangalore (NTI) and implemented in the early nineteen-sixties [paragraph A1]. In 1970, NTI wanted to evolve NTP by carrying out research to (1) improve the general health services (GHS) with which NTP was integrated and (2) solve the unethical problem of chest symptomatics (CS) being grossly neglected by GHS [paragraph A2]. Compartmental thinking stood in the way and badly affected the growth of both NTP and NTI [paragraph A3]. Even now, many recommendations of the Institute of Communication, Operations Research and Community Involvement (ICORCI) may need urgent attention, particularly those regarding improvement of case finding, fuller integration of NTP with GHS and improvements in management, even though the last item has been addressed to an extent in the past decade or so [Sections B & H]. An experiment to improve the functioning of primary health centers (PHCs) through better supervision at sub-district level, develop all curative services in rural areas and thereby improve tuberculosis (TB) case detection is suggested [Section C]. Some problems in public-private partnership are discussed [Section D]. Research studies have clearly shown that at least two-thirds of TB cases did not need full treatment, as designed under Revised National Tuberculosis Control Programme (RNTCP) [Section E]. These important findings did not receive proper attention. This has resulted in the implementation, continuation and augmentation of non-ethical treatment practices under RNTCP, a government-run programme. The need for further studies to evolve methods for identifying cases that require no treatment, short treatment or full treatment, is emphasized [paragraph E5]. Some other ethical issues needing attention are also highlighted [Section F]. Attention has been drawn to the possibility of a steady natural decline in TB [paragraph E2]. RNTCP has strengthened top and bottom levels of the programme but sidelined the state level. This omission and some other serious management issues need attention [Section H]. The need to convert NTI into an institute for tuberculosis and chest diseases and to set up similar regional institutes is reemphasized [Section J]. The current definition of chest symptomatics does not permit sputum examination for those who take early action [Section K]. Trying out two revised definitions to choose a better alternative is suggested. Some instances of dogmas, “crying wolf”, hectoring and misplaced emphasis are pointed out [Section L]. In spite of presenting itself as a national control programme, seemingly designed to control tuberculosis, RNTCP seems to be rather working as a complacent treatment programme that diagnoses and treats a small proportion of cases in the country [paragraph M1]. Evidently, RNTCP is neither national nor can it control TB, besides being unethical in many ways [paragraph M1]. It uses DOTS, by design, despite (a) clear evidence that it is grossly unethical [paragraph E4 and Section F] and (b) its inability to provide higher cure rates [Section I]. Some urgent steps needed for formulating and implementing an efficient, effective and ethical programme for control of tuberculosis and its evaluation are listed [paragraph M3].
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