A study was undertaken with the following objectives: (1) To estimate the proportion of population that would be available for resurvey after 5 years. (2) To ascertain five years later the fate of persons with X-ray pathology. (3) To compare the prevalence of tuberculosis in the villages at an interval of 5 years. Population of 15 of the 31 villages from the Madanapalle zone, was selected for this study. About 9,500 persons were registered and 7,200 were X-rayed at the initial survey. Five years later the same population was re-examined and nearly 70% were available for X-ray examination. Sputa were collected from persons with abnormal X-ray shadows interpreted as such by either of the two readers. Two spot samples were collected within an interval of 1-3 days and were examined by direct smear and by culture.

Analysis of the data shadow showed that: (1) There was no significant difference in the prevalence rates i.e., 3.6 and 4.6 per thousand respectively at two points of time. (2) During the interval, 30% of active cases had died and 20% were still active at the end of 5 years. (3) There was almost complete turn over of the bacillary cases during the 5 years interval.

National tuberculosis programme reaches people through PHCs and sub centres. A study was conducted to find out the perception of illness and utilisation of health facilities by the community. This study was conducted in a random sample of 48 villages selected according to Probability Proportioned to Size within 5 Kms of the selected PHIs in Kolar District using a Multi stage sampling technique. Information on socio economic status, availability of health services and their utilisation was collected. 13,323 individuals were interviewed. 706 were ill in a period of two months prior to survey. 71.3% had taken allopathic system of treatment. 69.1% had approached government hospital or PHC. 34 patients reported to have TB. All had attended either DTC or PHC.

The study indicated that morbidity was perceived much early and also followed by an action. Data indicates a high percentage of preferring allopathic system in general and from peripheral health centres and other Government hospitals in particular. Data indicates that in spite of overall backwardness of the study area and very limited economic resources people have utilised the PHC to the maximum. The reason could be either high acceptance of PHC or inevitability. But, there is an evidence of higher utilisation of family welfare and MCH services. The data shows all tuberculosis patients have had exposure to standard regimens, all of them have approached either PHC or DTC for treatment. This confirms the felt need oriented concept of National Tuberculosis Programme. Also high level morbidity among children below 4 years of age and action taken indicate an enhanced level of demand for health services.

The Health Intelligence System has to provide information for the planning, monitoring and evaluation of the Health Services which are provided by the Health Care Delivery System in the country. The Health Intelligence System should also be in a position to provide information on the health needs and demands of the community so that the Health Care Delivery System can plan to meet the unmet demands and needs. Information available is quite often incorrect, incomplete and out dated. Appreciable improvements can be effected only on the basis of a critical appraisal of the system. Some of the important reasons are lack of training, aptitude and sense of involvement in the work by the staff, improper reporting proformae, enforcement of targets, absence of discrimination between routine and special health intelligence, quantitative and qualitative data and lack of systematic & regular supervision by health administrators particularly at the district level. Suggestions for improvement are better utilization of collected data, simplification of proformae, adequate training to the staff in health intelligence, realistic variability of targets, integration of health intelligence for various components of the health care delivery system, bifurcation of data into two i.e., simple routine use and for use for special purposes and regular and systematic supervision and make suggestions for taking top level decisions. The major gaps and other problems listed in this paper and the suggestions made to overcome these are of such nature that these have to be considered at top levels and decisions taken, preferably on the basis of the observations and recommendations of a study group of experts set up for the purpose. Until some basic changes are made, the Health Intelligence System will continue to be thoroughly inadequate for proper planning, monitoring and evaluation of the Health Care Delivery System.