|Year : 2007 | Volume
| Issue : 3 | Page : 81-82
RNTCP : Observations, doubts and suggestions
Rajinder Singh Bedi
Bedi Clinic & Nursing Home, Sher-E-Punjab Market, Patiala - 147001 , Punjab., India
Rajinder Singh Bedi
Bedi Clinic & Nursing Home, Sher-E-Punjab Market, Patiala - 147001 , Punjab.
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bedi RS. RNTCP : Observations, doubts and suggestions. Lung India 2007;24:81-2
The The Revised National TB Control Programme (RNTCP) was launched in India in 1997 after pilot testing. Since then, it is expanding very fast and by December 2004, 942 million of the Indian population has already been covered under RNTCP.
I am a humble chest consultant in private sector. I have firm belief in RNTCP as it is technically very sound. Yet, I have certain observations, doubts and suggestions about RNTCP which I want to share with the readers and the policy makers.
- India has one of the largest private health sector in the world, with an estimated 8 million private practitioners PP2. Nearly 50-80 percent people with chest symptoms suggestive of TB seek help from the nearest and trusted PP2. Yet only 3000 PPs (0.04 percent) have been involved in RNTCP by December 20033. The sooner we involve PPs in RNTCP, the better it will be.
- The PPs are erroneously labelled as poorly qualified and profiteers, making wrong diagnosis and doing wrong treatment. In contrast to this, still vast majority of patients go to them because of trust and personal touch. Thus there is an urgent need to rope in PPs and update them about RNTCP. Short certificate courses of four to six weeks may be arranged for them with the help of IMA, TB Institutions and medical colleges. The doctors of other systems can also be involved.
- Many PPs are reluctant to join RNTCP as of now, because they do not have sufficient man-power for carrying out defaulter retrieval, recording and reporting activities. Ways and means should be found out to fulfill this requirement. Financial assistance can be provided to PPs to recruit part time workers for carrying out these activities. Otherwise, existing DOTS providers can, in some way, be made responsible for carrying out defaulter retrieval activity about the patients put on treatment by PPs. Various NGOs can also play useful role for this purpose by providing man power or financial assistance. Otherwise involving private sector in RNTCP without fulfilling these basic requirements can be more harm than good.
- Sputum smear examination for acid fast bacilli has been recommended, rightly so, as the standard diagnostic technique under RNTCP. A vast majority of chest symptomatics have asthma, COPD, smoker's cough etc. Testing three sputum samples of all these patients enormously increases the work load of laboratory technicians, thus comprising with quality of sputum smear examination. In urban areas and at district hospitals, where facilities of chest Skiagram and/or 70 mm films are available, we can reduce this extra workload by testing sputum of only those patients who have doubtful shadows in their skiagrams. This will also improve the quality of sputum examination. Otherwise also, what ever we may go on saying, a vast majority of TB patients are not satisfied with the diagnosis of TB without a chest Skiagram. They can afford the cost of skiagram chest, if asked to do so. Thus at places, where radiology facilities are available, sputum smear can be limited to x-ray "positives". Thus will improve the efficiency of the programme. In one recent report from AIIMS Delhi, the sputum microscopy was carried out in only 311 out of chest symptomatic .
- Guidelines for management of paediatric TB under RNTCP have been formulated, but combipacks are not yet available. The local purchases made for the purpose are limited and often erratic. Regular supply of combipacks should be ensured.
- The duration of therapy for serious types of extra pulmonary TB cases under RNTCP is possibly inadequate. Although the efficacy of daily SCC regimens of 6-12 months duration has been well documented in various forms of extra-pulmonary TB5, the same may not hold good for the RNTCP regimens. Data in this regard is lacking. In one recent report from AIIMS, some patients with extra-pulmonary TB required extended treatment4. This aspect needs careful consideration and controlled clinical trials are the need of the hour.
- In a recently published study from National Tuberculosis Institute, Banglore6, a cure rate of only 67.9 percent was reported in smear-positive TB cases, much less than the claimed 85-86 percent by WHO and RNTCP. The results of a premier TB institute of India cannot be overlooked. Thus, there is a definite need to look into our reporting system to check out the possible inflated reporting.
- Direct supervision is the corner stone for the success of RNTCP. In our country, lot of stigma is still attached to TB. As a result, many patients, especially young females, who want to hide their ailment, do not go to DOTS-provider thrice or even once a week. Such patients often resort to influence the DOTS-provider and get medicines in bulk. In this process, direct supervision is lost. It is better if these patients are provided drugs at their homes by the DOTS-provider under direct supervision.
- In our medical education system, TB and RNTCP are often pushed to back seat by students as well as teachers as these are often considered 'unimportant' from examination point of view. There is urgent need to train all medical students about all aspects of TB and RNTCP and keep questions about RNTCP in all professional examinations. In this way, we will ensure adequately trained and informed doctors as far as RNTCP is concerned.
Through this communication, I want to stress the need for a realistic approach towards RNTCP. There is no reason to be over-enthusiastic, nor one should be pessimistic. RNTCP is very good and we can achieve desirable results, but only if we foresee these problems and find solutions with an open mind.