The National TB Institute in the national programme
The National TB Institute (NTI) was started with two main objectives.
Firstly, to develop a nationally applicable tuberculosis (TB) control
programme on a community basis and secondly, to train the key personnel
to execute this programme in the states.
Developing nationally applicable TB control methods
Before the establishment of NTI, most of the existing knowledge of
TB was confined to its clinical aspects and to the management of the disease
in the individual patient. At NTI, this knowledge was to be supplemented
by epidemiological, socio-economic, operational, organisational and administrative
knowledge to devise an effective programme for controlling TB in the community.
Work at three levels was initiated to develop the programme.
NTI conducted its own investigations on epidemiological,
social, economic and operational aspects of TB control. For this purpose,
the longitudinal survey and other epidemiological investigations,
awareness and action-taking studies, studies on economics of TB, of
patient behaviour and other sociological investigations, the operational
investigations of case finding methods and treatment organisation
The NTI planned different control approaches/methods
which were test run in a few districts. It carefully followed and
evaluated these test run programmes which were managed by the respective
state governments. The evaluation of these test runs provided new
material for investigations, for recommendations to the government
on the pattern of district TB Programmes. This also helped modify
its training programmes.
The NTI supervised and evaluated the expansion of
the National TB Programme (NTP). This helped to improve, modify and
evolve its own research and training activities. This exercise was
based on the quarterly reports it received from the state governments
and through the NTI staff visits.
Training of TB workers
The training is given to the in-service personnel for carrying out the
major activities of the programme as per the national guidelines. The
main emphasis of the training is imparting skills, orientation in public
health approach and providing managerial abilities. The trainees are largely
key-persons working in the District TB Centre (DTC), state level programme
implementers and policy makers. The trainees receive a broad grounding
in public health work before moving to specialised training in TB.
Each large state has got one State TB Centre (STC) which
has the functions like clinical, training and monitoring. The STC is to
assist in imparting the knowledge of the special techniques in TB control
to Primary Health Centre (PHC) level staff. The key staff of the STC are
trained at NTI as trainers and also as researchers to conduct research
of local importance.
The NTI imparts training to STC staff in basic subjects,
e.g. bacteriology of mycobacteria, epidemiology, maintenance of X-ray
units and monitoring of the programme. It was presumed that until the
full system of STCs has been established, it may be necessary for NTI
to accept general laboratory technicians, X-ray technicians and health
visitors as trainees. Monitoring and supervision of the programme is an
important function of the NTI mainly carried out by statistical section.
This helps to understand the gap between potential and performance of
the programme and reduce it as much as possible.