Tuberculosis (TB) remains a major public health problem in India. The Revised National Tuberculosis
Control Program (RNTCP) was launched by the government of India (GoI) with a goal to achieve 70 percent
case detection and 85 percent cure among new smear-positive (NSP) TB patients. This was expected to cut
the chain of transmission. In order to achieve the above objective it was essential to sensitize and train
private doctors in RNTCP. Private health care providers account for roughly 80 percent of first contact and
at least half of TB treatment in India.
GoI and the Indian Medical Association (IMA) came together in partnership, under The Global Fund to
address issues around public-private mix (PPM) in TB and launched the IMA GFATM RNTCP PPM project in
2007 in 5 states and 1 Union Territory (UT). IMA members who were private doctors were sensitized and
trained on the management of TB under RNTCP. The project was extended to 15 states and 1 UT under
Rolling Continuation Channel of GFATM through a memorandum of understanding (MoU) between GoI’s
Ministry of Health and Family Welfare (MoHFW) and IMA for 6 years (1st April 2009 to 31st March 2015)..
Since its launch, the project has generated awareness and goodwill for the national TB program amongst the
private medical fraternity. There is now global consensus that the earlier twin objectives for case detection
and cure among NSP may not be adequate to achieve the desired impact on the TB epidemic. Post TB
treatment mortality and default rates remain high, the major cause being delayed diagnosis. The National
Strategic Plan (NSP) for TB control in 2012-17 has set universal access to quality TB diagnosis and
treatment for all TB patients as the central theme to achieve 90 percent case detection and 90 percent
treatment success. In addition, government has banned serological blood tests in TB diagnosis and has
declared that TB should be notified on diagnosis, by all healthcare providers. IMA deems it a national duty
and desires to enhance its public health contribution.
Strategy: IMA membership spans over all sectors of the medical fraternity. IMA with its breadth of
representation and depth of penetration remains the ideal choice for being an interface agency with private
doctors.
Goal: To achieve universal access to quality TB diagnosis and treatment for all TB patients as the central
theme to fetch 90 percent case detection and 90 percent treatment success.
Key activities: Key activities carried out in the IMA PPM project listed below:
1. Conduct national and state/unit level review workshops annually for national and state IMA leaders.
2. Publish a quarterly newsletter dedicated to TB for all members of the IMA.
3. Publish articles on TB on a quarterly basis in the monthly IMA Journal (JIMA).
4. Reproduce and distribute information kits to IMA members.
5. Organize CME for IMA members.
6. Organize training on RNTCP, PPM-DOTS and international standards of TB care to private doctors.
7. Participate in World TB Day activities at the national, state and district levels.
8. Participate in and contribute to RNTCP national and state review meetings and conferences.
Objective
To improve access to the diagnostic and treatment services of RNTCP and thereby improve the
quality of care for patients suffering from tuberculosis in fifteen states and one union territory of
India, viz., the states of Andhra Pradesh, Bihar, Chhattisgarh, Gujarat, Himachal Pradesh, Jharkhand,
Kerala, Maharashtra, Orissa, Punjab, Rajasthan, Tamil nadu, Uttaranchal, Uttar Pradesh West Bengal
and the Union Territory of Chandigarh.
Project Scope
Reaching out to a about 150,000 practitioners of modern medicine in an area covering about 75% of
India’s population, the project is expected to create an impact on the quantum and quality of care
and support provided to patients suffering from tuberculosis and to their families.
The project will carry out capacity building of IMA members in 15 states and 1 Union Territory
through National and Unit workshops, Continuing Medical Education (CME) sessions at IMA local
branches and finally through training of committed doctors in each of the project districts. The focus
at each level will be to identify and involve physicians and general practitioners who are most likely
to influence the desired change, which is to popularize the use of standardized diagnosis and
treatment protocols for TB control in the country(STCI).
In addition to direct interaction and face-to-face contact, the project will communicate important
aspects of the national TB program, STCI and new evidence based developments in TB control to IMA
members in the project states through regular newsletters, journal articles and Information
Education and Communication (IEC) material. The newsletters and journal articles will also discuss
issues, concerns and FAQs pertinent to the medical profession in the context of TB management.
Through its efforts, the project will play the role of a catalyst in the involvement of medical
professionals, especially private practitioners, in RNTCP and in the establishment of peripheral
health institution (PHI) at the clinics and hospitals run by them. This is expected to improve and
advance the diagnosis of TB and contribute early treatment, notification of TB cases with improved
prognosis and outcome. With their involvement in RNTCP, doctors are expected to make it more
convenient for patients (and their families) to access TB treatment through medical service
providers, and timings, of their choice.
The project expects that with the achievement of a ‘critical mass’, in terms of medical providers
involved in RNTCP, there will be widespread endorsement of DOTS and the STCI by professional
medical associations and individual practitioners, including those outside the membership of the
Indian Medical Association. With greater acceptance and spread, the treatment of TB would be
uniform, rational and evidence based and contributes to a decrease in the burden of disease and
improved national productivity.
Indicators: As per the MoU with GoI, the key indicators are:
1. Number of review cum workshops held at national and state level
2. Number of Private Medical practitioners reached through CME
3. Number of private providers trained in DOTS
4. Number of issues of RNTCP-IMA newsletter and IMA journals published and distributed to all IMA
members
5. Number of IMA members from the project who have signed an MOU under one of the RNTCP PPM
schemes
Key Performance indicators:
1. Facilitation of number of TB cases notified by the private practitioners, & private health providing
facilities
2. Facilitation of number of PHI establishment by the private practitioners,& private health facilities.
At National Level: National Working Group (NWG) is the policy making body and constantly monitors and
reviews the implementation of the project. It submits periodic reports to the CWC and Central Council. It
also submits the necessary reports and accounts to the Government of India and GFATM through the Central
TB Division (CTD). The NWG interacts regularly with key partners including CTD and WHO. The National
President and Hon. Secretary General are ex-officio members of the NWG. All the funds are received and
dispersed by IMA HQ through a separate account for the project being operated by the Secretary General
and Finance Secretary as per IMA Rules.
Download the contact details of NWG members
The project has 27 hired Medical Technical Consultants who are working at the grass root level. They are
the technical resource in the field and in direct contact with the private/public sector. They are expected to
help in planning and organizing the State Workshops/Review Meetings, branch CME’s and DTPs. The
primary responsibility of IMA Technical Consultants is to motivate the doctors for TB notification &
establish the PHI( private sector) under the existing schemes of RNTCP .
The details of the states/ units/consultants are given below:Project States/UTs
*Area
(in000 sq
km)
*Population
*No. of
Districts
**No. of
Branches
**Total IMA
Membership
No. of
Units
1. Bengal
98,048
85,369,608
19
162
12,454
2
2. Bihar
94,163
82,998,509
37
107
5,951
2
3. Chhattisgarh
135,191
20,833,803
16
25
1,433
1
4. Gujarat
196,120
50,670,013
26
118
18,382
2
5. Jharkhand
79,714
26,945,829
22
31
2,970
1
6. Kerala
38,863
31,841,374
14
97
17,426
1
7. Orissa
155,707
36,804,660
30
38
2,869
1
No. Name of State/UT
8. Rajasthan
342,239
56,507,188
32
61
4,850
1
9. Tamil Nadu
135,194
63,952,379
31
142
18,998
3
10. Uttaranchal
53,479
8,489,349
13
26
1,345
1
11. Andhra Pradesh
275,069
76,210,007
23
155
17,321
3
114
900,635
1
1
783
1
13. Punjab
50,362
24,358,999
17
60
5,108
-
14. Himachal Pradesh
44,212
21,144,564
20
43
2,955
1
15. Maharashtra
307,577
96,878,627
35
177
20,838
3
16. Uttar Pradesh
240,917
166,197,921
70
117
11,859
4
2,246,969
850,103,465
406
1,360
145,542
27
12. Chandigarh
Total
*Source: Official site of Govt. of India (http://india.gov.in/)
** Source: IMA data base, March 2008
Download the list of Unit coordinators & Technical consultants
Name of
the phase
&
time
perod
Round-6
(Oct-07 –
Mar-10)
RCC
(Apr-10 –
Sep-11)
No.
of
sensitized
31,664
28,462
PP No. Of PP Number of No.
of Number of No. of Formation
trained
MoU signed DOTS
DMCs
TB
of PHIs
centers
formed
patient
created
notified
5,410
2,287
2,230
57
NA
3,193
2,317
497
13
NA
-
SSF-1
28,244
6,699
(Oct-11 –
Mar-13)
SSF-2
10576
896
(Apr-13 –
Mar-15)
TOTAL
98946
16,198
( Till september 2014)
2,347
1,587
27
NA
-
534
73
7
66107
1224
7,485
4,387
104
66107
1224
TB notification
In order to ensure proper TB diagnosis and case management, reduce TB transmission
and address the problems of emergence of spread of Drug Resistant-TB, it is essential to
have complete information of all TB cases. For this purpose , The Ministry of Health &
Family Welfare, Government of India has declared TB as a mandatory notifiable disease
on 7th May 2012, by an executive order.
Making TB a notifiable disease, will, perhaps, yield some positive outcomes – for
instance, all private doctors or healthcare providers, laboratories and other caregivers
will have to report every single case of TB to the government which will surely give a
more real situation analysis of the burden of TB, where TB patients are getting treated
and who is treating them (public or private healthcare centre), and other data that
might have a positive outcome on public health aspect of TB control
Download the Tb notification guidance tool
Ban on Serological Tests for TB in India
Serological or sero-diagnostic tests for TB means diagnosing TB through looking at a
blood sample, and specifically looking for antibodies in the blood sample. Some diseases
such as HIV can be diagnosed very easily by taking a blood sample, and then doing a
procedure that looks for antibodies in the blood sample. But one cannot diagnose TB
this way.
Testing for TB by detecting antibodies in the blood is extremely difficult. People can
have antibody responses suggesting that they have active TB even when they do not.
Antibodies may also develop against other organisms that again could wrongly indicate
that they have active TB
As a result commercial serological tests for TB, sometimes called sero diagnostic tests
(such as the Anda-TB IgG) have very variable results and this generally means low
sensitivity and specificity. If a test has low sensitivity, it means that there will be a
significant number of "false negative" results, which indicates that a person has not got
TB when they actually have got TB. Similarly, a low specificity means that there will be a
significant number of "false positive" results. These suggest that a person has got TB
when they actually haven’t TB.
In July 2011 the World Health Organization issued a warning that such blood tests
should not be used for trying to diagnose active TB. They said that:
“Test results are inconsistent, imprecise and put patients' lives in danger.”
In June 2012 the Indian government Ministry of Health and Family Welfare, banned the
manufacture, import, distribution and use of serological test kits for the diagnosis of TB.
In late December 2012, the Ministry of Health and Family Welfare, took out
advertisements in national newspapers, again explaining that the use of serological tests
kits for TB is banned, because of the lack of accuracy of the tests.
This does not mean that there are no tests available for diagnosing TB. They are sputum
tests, culture tests and newer molecular tests can be used, and that free diagnosis &
treatment is available in Revised National TB Control Program.
Peripheral health institution (PHI): A PHI is a health facility which is manned by
at least one medical officer. All health facilities in the private sectors participating
in RNTCP are also considered as PHIs by the program. Some of these PHIs also
function as DMCs (.Designated microscopic centre). For a PHI drug store has to be
maintained. There is a monthly reporting format is to be filled by the concerned
medical officer.
Download the monthly phi reporting format.
Financial guidelines-For financial guidelines the blue book manual can be
downloaded.
Download the blue book manual
Success stories
The success story of Tb notification of Gujarat:
So far Gujarat state has notified 11111 TB cases till September 2014 which is maximum form
any of the project state.
Gujarat has published FAQs & Tuberculosis Notification format in monthly news bulletin of
GSB, IMA. Many of the Gujarat IMA branches proactively circulated a TB circular to each
member mentioning that TB notification is compulsory for every member and the branch is
committed for the cause. Contact details of the respective District Tuberculosis Officer were
also shared with all the members. In short there is a constant endeavour and a sincere
effort of to educate all members to notify all the tuberculosis cases and provide quality care
to Tuberculosis patients.
In Mehasana district the initial notification has been very low. In the month of February ’14
only 21 cases were notified. Subsequently 3 CMEs and 1 DTP in Mehsana district was done
with the main focus on Tuberculosis Notification. Now the average notification from the
district has come up to 80 -100 TB cases per month. In the end due to sustained efforts and
collaboration with government officials and local IMA branches we could achieve the result
which was desired.
Success story of Satara , Maharastra
The initial notification of Satara district was also quiet low, 30-40 cases per month . in the
month of may ’14 5 CMEs were organized in the district with the main focus on Tb
notification. The TB notification swung high 400-500cases per month. The doctors notifying
the maximum TB cases were given recognition & felicitated.
Success story of AP
Kamala Nursing at Vishakapattanam:- This is a private nursing which started as dot centre
under the IMA Gfatm RNTCP-project . in last 8 months it has examined 241 suspects & out
of which it has notified 85 cases& put them under treatment.
Success story of Kerala:
IMA TB Notification system: email and SMS based system where private hospitals would notify to IMA
from where reports would be disseminated to concerned DTOs. This has simplified the process and
has gained confidence of private practitioners. Many Private practitioners are happy to notify it to IMA
but not to government. Attractive Posters in all doctors room, brochures on notification, 2 min
advertisement video on notification, advertisements in IMA News, personal communications to
hospital administrators has helped to disseminate the message and facilitate notification
IMA Kerala has initiated daily regimen drug wise boxes for the patients of tuberculosis. For
the compliance of treatment. This has been initiated by the private sector doctors of kerala.
Though follow up is a challenge for which some mechanisms has to be thought of for the
patient defaults.