This paper, read at the 10th TB Workers’ Conference in Mysore, 1953, emphasises that, typically, non-official agencies in most countries have initiated the fight against TB and lists the essentials of TB services. The government’s responsibilities in TB control are described and there is a detailed account of the origin and history of non-official anti-TB effort in India. Three key factors are offered for consideration in planning the future of TB Associations and their work in India: 1) The importance of definite programs such as educative propaganda, welfare activities and, starting and running institutions for TB patients, 2) The composition and control of TB Associations, 3) The functions of the central Association.

The editorial makes a case for encouraging the partnership of NGOs with the NTP to fight TB. The attitudes and perceptions of the Government, on one hand, and the NGOs, on the other, make this a complex proposition. Several reviews of the NTP’s performance over the last three decades concluded that the NTP’s achievements were below expectations despite notable progress made in some directions and that the programme was not likely to improve without better programme management and active participation in TB control activities by the people. Therefore, the Government, after the Surajkand deliberations in September 1991, accepted the recommendations of the TAI, one of which was the necessity to develop partnerships with NGOs. The changed facade of the NGOs, today, because of the large number of professionals that have joined them, adds to the benefits the NGOs would bring to a partnership. How the partnership should begin and the various mutual benefits for the Government and the NGOs in becoming partners are described.

In the fight against TB, a partnership exists among three important sectors: the public, the health professionals, and the government. This chapter will deal with two of these three partners: the public and the health professionals.

A simple relationship between a patient and the doctor as individuals through community-oriented national TB programmes is part of the global fight against TB. The responsibility for having a national programmme rests with the government; it is up to the health authorities to design, staff, implement, assess, and orient the programme. Although this is generally accepted and would seem fully logical today, it is remarkable that the first organized effort against TB (which in many instances led the way to other public health measures) originated from the voluntary combination of the energy of physicians and the public in an attempt to relieve suffering, prevent disease, and disseminate information. Thus were created at the end of the past century and the beginning of this century, voluntary associations that gather together lay individuals and professionals to develop the first elements for the concerted effort to fight TB. In most countries, even though governments have taken the responsibility for providing health services in relevant programmes, the success of any governmental programme continues to depend on the competence and attitudes of professionals who are delivering the programmes and on the active and understanding participation by the people in the measures offered them.

Voluntary NGO are the best means of ensuring high standards in the application of the professional and governmental measures and the widespread participation of the public in any control programme. This includes lobbying for improvements and acting as a “watchdog” for the programme.

A study of NGOs was undertaken in Maharashtra and Gujarat to assess the extent and the type of NGOs’ contribution to TB control and to determine ways to strengthen it. The analyses of responses to a mailed questionnaire by 77 NGOs in Maharashtra and 57 from Gujarat and, in-depth case studies of 13 NGOs, selected purposely to understand their functioning and to evaluate the effectiveness of their approaches to control TB, are presented. Regarding the nature of anti-TB work by NGOs, about 50% were dependent on public health services for one or more of their programme components and, about 40% had activities comprising case-finding, treatment and case-holding. Variations in NGOs contribution between the two states were marked. One-third of all cases detected and started on treatment by the Gujarat State TB Programme were reported by NGOs, while in Maharashtra, case-detection by NGOs was an insignificant 3.5%. More organizations and better facilities were available in Gujarat. The NGO approaches for offering anti-TB services fell into four categories: 1) Institution, Hospital or Clinic-Based programmes, 2) Use of Community-based workers, 3) Use of Public Health Services and, 4) Involving Private Doctors. Concerning technical aspects, all NGOs depended on X-ray as a diagnostic tool and most NGOs used SCC for all their patients. The weakest aspect of most NGO programmes was non-maintenance of records and failure to use proper records to assess or improve programme implementation. To improve treatment adherence by patients, NGOs used various approaches such as using part-time village-based functionaries of another health care programme and home delivery of drugs. For the NGOs, individual donations formed the most important source of funding. Ways by which NGOs and governmental agencies could support each other are suggested.

NGOs make a vital contribution to disease control that is increasingly recognized by governments and international development partners. This booklet provides examples of the important contributions NGOs are making to TB control in the region and provides guidelines for NGOs wishing to get involved in the fight against TB.

This is not only a record of success, but also a call for action – a plea for more and more agencies to collaborate and develop partnerships with national TB programmes. And the plea goes out to all organizations – not only those with a historical interest in TB. All organizations – including those working in community development, advocacy, human rights, education – have a role. TB affects us all in one way or another – directly through its impact on the lives of friends and colleagues who have TB, and indirectly through the impoverishment of families and communities. All of us can be, and should be, involved.

This study was conducted to evaluate the effectiveness of unsupervised monthly-monitored treatment using an oral short-course regimen in hill and mountain districts of Nepal supported by an international NGO. In this prospective cohort study, outcomes for new cases of smear-positive TB starting treatment over a two year period in four districts in which a 6 month rifampicin containing regimen was introduced as first line treatment (subjects) were compared to outcomes for similarly defined cases in four districts where a 12 month regimen with daily streptomycin injections in the intensive phase continued to be used (controls).

Of 359 subjects started on the 6 month regimen, 85.2% completed an initial course of treatment compared to 62.8% of 304 controls started on the 12 month regimen (P < 0.001); 78.8% of subjects and 51.0% of controls were confirmed smear-negative at the end of treatment (P < 0.001). The case fatality rate during treatment was 5.0% among subjects and 11.2% among controls (P=0.003). Among those whose status was known at two years, 76.9% of subjects were smear negative without retreatment, compared to 60.9% of controls (P < 0.001).

In an NGO supported TB control programme in remote districts of Nepal, patient responsible short course therapy supported by rapid tracing of defaulters achieved acceptable outcomes. Where access and health care infrastructure are poor, district-level TB teams responsible for treatment planning, drug delivery and programme monitoring can be an appropriate service model.