Indian Council of Medical Research, New Delhi: Report of ICMR Expert Committee 1975

In 1975 recognising the importance of the TB problem, Govt. of India, Ministry of Health & FW, on suggestion of TB Association of India, requested ICMR to constitute an Assessment Committee who should evaluate the National Tuberculosis Programme (NTP) and submit a report. A committee consisting of five members reviewed the NTP in terms of i) aims & objectives of the programme, ii) implementation and iii) performance at various levels. Its shortcomings and various factors responsible were identified. Recommendations to improve the functioning of NTP in all the aspects were suggested. The country was divided into 5 zones; south, west, centre, north and east. Two District TB Centres (DTCs) from each zone were selected for the study. The data was collected by posting proformas to all the State and Union Territories and by visits of the expert committee members in groups to different regions in the country. The members obtained information from state headquarters, DTC, Primary Health Centre (PHC) and villages.

The committee observed that the general pattern of the District TB Programme (DTP) does not require any change; however, it requires strengthening in many ways. The performance of the DTC and Peripheral Health Institutions (PHIs) was found to be far from satisfactory in terms of Case-finding, case holding and BCG vaccination. Since the implementation and supervision of the programme was the responsibility of the State and which were found to be the weakest components of the programme, it was strongly felt by the committee that the programme should be made a truly national programme by making it centrally sponsored for the next 10 15 years and the centre should exert direct control over the programme instead of being left to the state for administering it. The committee observed that the programme has not been implemented in 57 districts in 15 States especially in Bihar where out of 31 districts only in 3 districts the programme has been implemented. Utmost priority should be given to implement the programme in the remaining districts especially in Bihar. The integration of programme with the General Health Services has not been satisfactory thus leading to poor functioning of Peripheral Health Institutions (PHIs). The poor performance of DTP was mainly due to limited contribution by the PHIs. The other shortfalls observed by the programme were lack of adequate supervision and control by the State TB Officer (STO), District TB Officer (DTO). Most of the centres including DTC were mainly serving the patients of the town in which they were situated. Thus, a large part of the rural area was not covered by the programme. The drug supply was adequate throughout the country except SM & PAS in some states where doctors were fond of using SM for every patient and preferred PAS to Thioacetazone as standard companion drug. There was shortage of MMR films and lab reagents in many of the DTCs. Equipments like MMR, microscopes, and vehicles were out of order for long periods for want of maintenance facilities. It was recommended that the Central Government should have equipment maintenance organisation and should be responsible for supply of the drugs, equipments, films and maintenance of the equipments. The status of the Tuberculosis Adviser should be of the rank of Deputy Director General, State TB Officer that of Deputy Director, Health Services and the DTO that of the DHO/DMO. There should be 5 Regional Centres with a Deputy Director In charge, supervisory staff and adequate funds. The functions of the Regional Centres will be to exercise supervisory control over the programme in the region. BCG vaccination coverage in the eligible population of 0 19 years age was found to be 10%. It was decided to change the strategy of BCG from mass approach to the integrated one i.e., with immunisation programme, for effective coverage. It is desirable to have periodic evaluation of the NTP. Therefore, there should be a permanent evaluation cell at the centre. There should be one TB worker and one microscopist exclusively for tuberculosis work at every PHC. There should be active community participation in the villages. The village headman and teachers should give adequate publicity for sputum examination and regular treatment. The TB workers at all levels should be debarred from private practice and should be given suitable non- practicing allowance. Active involvement of other governmental bodies like ESI, Army Health Services, CGHS, Railways etc., in the tuberculosis control by providing Case-finding and treatment facilities to all their beneficiaries and eligible patients as per the programme recommendation. Of the five State TB Demonstration Centres the work was found satisfactory only in Nagpur. Some training activity was going on there. Lack of political will and all pervading human apathy was visible at all levels. The committee felt that a strong 'political will' to give due priority to the programme was required.