A : Problem Definition
Stig Andersen & M Piot: Proceed Natl TB & Chest Dis Workers Conf, Bangalore, 1962, Souvenir 16-19.

The National Sample Survey demonstrated that tuberculosis is one of India's major public health problems, disease being equally prevalent in both rural and urban areas. To bring about the reduction of the tuberculosis problem in a limited time the programmes developed at National Tuberculosis Institute (NTI) must have the following characteristics: i) they must be firmly rooted in the general health services and contribute to their development. ii) they must be applicable to the large majority of the districts of India. The existing clinical knowledge of tuberculosis should be brought to the realm of public health application, for which NTI must accumulate a body of knowledge on the efficiency of various control programmes under field conditions and their operational feasibility.

Operations Research at NTI consists of following elements (i) Data collection on (a) epidemiological factors by conducting base line and longitudinal surveys (b) operational factors by comparing Mass Campaign approaches and Community Development Approaches (c) Sociological and economic factors by studying the awareness of symptoms among TB patients, economic consequences of TB and acceptability of long term drug treatment (ii) construction of various epidemetric and operational models to give information on the efficacy of various tuberculosis programmes (iii) test run at the moment NTI is operating a District TB Programme (DTP) in Anantapur and a city programme in Bangalore. These programmes have been formulated to a large extent on the basis of preliminary data not organised in model form. Some provisional conclusions are beginning to emerge from the various elements of the Operations Research Programme operating for a year. The general health services are proving to be capable of playing their essential role in the diagnosis and treatment of tuberculosis, provided they are assisted, at district level, by a special tuberculosis service for planning, partial supervision, evaluation and referral. With existing chemotherapy the treatment organisation is the most crucial part of the tuberculosis services, and the decisive role is played by the field organization engaged in preventing and curing treatment default. The most critical requirement of any control programme is an ample provision of drugs, to be supplied free of cost to the patients. Over half the X-ray active cases (including more than three quarters of the sputum positive cases) are aware of symptoms of the disease, and Case-finding can therefore, for some time to come, be based on the self advertising attraction of a free treatment service within a walking distance, associated with a simple sputum diagnosis at Primary Health Centre level and referral X-ray diagnosis at taluk or district level. NTI's task is formidable, its resources limited. We believe that through its Operations Research Approach, NTI utilises most effectively its limited facilities towards the solution of India's tuberculosis problem.