The principles of TB control, which are based largely on research done in India and grounded in Indian realities, apply to all providers without exception. Good TB control is good TB control. There are five such principles:

First, commitment and dedication. TB is truly a life or death problem. Untreated, a single patient with TB will most likely be dead within two to three years, and will have spread his infection to dozens of others. As we all know, no programme can succeed without sincere and dedicated effort.

Second, good quality diagnosis. All too often, patients with TB are diagnosed late because the doctor has not recognized their TB disease and not ensured good quality microscopic examination of sputum. Also, all too often, patients who do not have TB are treated for the disease unnecessarily. Fortunately, a very effective and very widely applicable technology for effective diagnosis of TB is available. This is the sputum smear microscopy, which can be done by para-medical workers with limited training, as long as supplies are uninterrupted and supervision occurs. This is not to say that X-ray has no role to play in the diagnosis of TB. For patients who are not having positive AFB smears, X-ray is an important complementary tool.

Third, effective treatment with good quality drugs. Current treatment regimens for TB cure more than 95% of patients who take them. However, all too often, physicians do not use proven regimens, and failure to complete treatment is, sadly, the norm rather than the exception in both public and private sectors not implementing the RNTCP.

Fourth, effective case management, including direct observation of treatment. We all know the inevitable tendency of patients of all types to stop taking medicines prematurely. This is no less common even among the medical fraternity. The only way to ensure that patients take their medicines as prescribed until they are cured is to watch and help as they do it. This should not be a mechanical function, but should be an act of caring and human bonding.

Fifth, systematic monitoring and accountability. The RNTCP has a superb system for monitoring each and every patient placed on treatment. I challenge you to apply this system to each and every patient you diagnose in every office in which you work. In this system, the TB control programme and not the patient is responsible and accountable for ensuring cure.

The results of application of this strategy have been remarkable. India has completed one of the fastest expansions of DOTS ever to be done anywhere, and this year is likely to treat more patients under the DOTS strategy than any other country.