The panel discussion highlighted some basic administrative, organizational, technical and patient factors relevant to the problem of Treatment Default in the TB programme. In urban areas, the proper motivation of the patients, keeping of suitable records, prompt defaulter-action, adequate supply of drugs and the need to provide suitable facilities for patients coming from outside the clinic area, constituted the key administrative and organizational factors affecting treatment default. Regarding technical considerations, there was a need for a more precise definition of a case. It was pointed out that a large proportion of the patients were not really defaulters either because they were not cases of pulmonary TB at all or the patients took treatment from outside the clinic. Also, many so-called defaulters took the treatment after the expiry of the 12 months, while some were resistant to the treatment offered at the time of their first registration. In rural areas, the TB programme could only be strengthened with a concurrent strengthening of the over-all health administration.

A two-year follow-up study of treatment default among 193 patients with pulmonary TB, who were receiving domiciliary treatment in a Delhi urban clinic, revealed that the percentage of defaulting (that is, collecting drugs for less than 10 months) fell from 57% to 44% when the duration for calculating drug collection was raised from 12 to 24 months. The propensity to default appeared to be inversely related to the precision of diagnosis and the extent of lesions. While the default rate was 20.2% among those who were initially sputum positive, it was 100% among those sputum negative cases who had only minimal radiological lesions. This study, thus, questions the rationality of assessing the performance of a TB clinic on the basis of the ‘traditional’ definition of a defaulter. It has presented data to make a case for a more precise definition of a defaulter by offering a longer period for calculation of drug collection and by stressing the need for greater precision in diagnosis of cases who are put under treatment.