District Tuberculosis Programme (DTP) was formulated in 1962 with one of the objectives of diagnosing maximum number of tuberculosis patients. The rural health institutions implemented as Peripheral Health Institutions (PHIs) are expected to play a major role. The PHIs according to the type of facilities available, are classified into X-ray Centres (XCs), Microscopy Centres (MCs) and Referring Centres (RCs). While all centres provide treatment, XCs offer chest X-ray and sputum microscopy examination; MCs offer only sputum microscopy and from RCs sputum slides are prepared and referred for further examination to DTC/XCs/MCs. The performance of DTP activities at PHIs are collectively reported. Hence, it was worth studying categorywise performance of PHIs, which may help in developing strategy for improvement in the performance of the National Tuberculosis Programme.

OBSERVATIONS : DTP is operational in 390 (89%), out of the 438 districts in the country. Of the 17,850 implemented PHIs, 2390 (13.7%), 8717 (48.8%) and 6740 (37.8%) are functioning as XCs, MCs and RCs respectively. In all, 208 DTP reports for October to December 1993 quarter received at National Tuberculosis Institute, were analysed. Reporting efficiency of XCs, & MCs was 85%, whereas of RCs, 54%. Of the 33.1 million self reporting outpatients belonging to various PHIs, 35% attended XCs, 43% MCs and 22% RCs. Of the total sputum examinations performed during the study period, XCs examined 39%, MCs 52% and RCs 9%. Selection of chest symptomatics worked out to 1.8% for XCs, 2.0% for MCs and 0.7% for RCs. Out of the total 28,654 smear positive cases diagnosed, 56% were detected by XCs, 37% by MCs and only 7% by RCs. It is seen that XCs diagnosed 56% of the total cases by doing 39% of the total sputum examinations. The sputum positivity rate at XCs is 7.8% which is almost double that of 3.8% at the MCs and 4.4% at RCs.

Sputum Examination Efficiency (SEE) and Case Detection Efficiency (CDE) (percentage of achievement compared with expectation) have also been compared according to the category of PHIs. SEE of XCs & MCs were 70% & 78% respectively as compared to only 26.5% in RCs. The CDE of XCs, MCs & RCs were 69.1%, 36.9% and 14.1% respectively. It is observed that XCs are working satisfactorily as 35% of the total out patients attend the XCs, their reporting efficiency being 85%, sputum examination efficiency 70% and sputum positivity rate 7.8%, indicating good performance, while MCs had a low sputum positivity rate of 3.8%, suggesting that there is a large scope for qualitative improvement in Case-finding activity. While RCs cater to about 20% of the total out patients had poor performance on all account and need a great deal of technical supervision.