4. 5. Work on the training front
From the outset, the NTI gave priority not only to the
training of DTC key personnel but the quality, duration and content of
the training activities were constantly reviewed and upgraded. During
the two decades, there had been a steady growth in the area covered and
the number of trained personnel available for NTP in the country. By 1996,
72 regular training courses for DTP key personnel had been conducted.
However, the NTI was not satisfied because the NTP was functioning below
expectations. It had not shown the steady progress warranted by the ever
increasing burden of disease to fight it effectively.

Dr B Shankaran, DGHS with Dr A Banerji Director (Standing to his left)
inaugurating the new training block on 16.9.1980 |
The reasons were apparent. Despite the fact that the
NTI tried to enthuse the state governments, there has been a steady decline
in the number of trainees being sent, for all the categories. Sufficient
importance was not given to sending appropriately qualified personnel
for training or, effectively utilising the benefits of training by keeping
the trained ones in the TB field. While some states stopped sending trainees
altogether, some others were lukewarm in their response. There was also
the proverbial budgetary restriction. This affected the drug supply and
consequently the programme.
In order to become more accessible to those who are quite
at a distance from Bangalore, an unusual step was taken during 1990-91
to hold the Group Educational Activity (GEA) at different places of India,
at convenient locations, so as to cover different states. For e.g., they
were held at Chinsura and Hoogly (West Bengal); Aurangabad (Maharashtra),
Chindwara (Madhya Pradesh), Agarthala (Tripura), Ahmedabad (Gujarat),
Hyderabad (Andhra Pradesh), and Ajmer (Rajasthan). The GEA was a platform
for information dissemination. The GEAs received support from the respective
governments and there was an appropriate response in terms of the number
of trained, untrained personnel. These included senior administrators
also111.
From early days, NTI began to organise two months to
six months training programmes for young scholars in research methodology.
The NTI developed different kinds of training/orientation/familiarisation
strategies for academicians, PGs, researchers, administrators and special
groups (Bacteriologists, Epidemiologists). To suit the different needs,
it evolved course contents for seminars, workshops and Continuing Medical
Education (CME). In 1995-96, 305 medical students from five medical colleges
of south India visited the NTI for the briefing courses. Fifteen MOs and
one para medical were briefed in TB control and other specified areas
that year under the WHO fellowship. Occasionally, medical students came
from USA, Canada and England for their tropical posting.
The NTI had also acknowledged the need to decentralise
the training of DTC key personnel and transfer the responsibilities to
the STCs so that each state became more independent. One of the main purposes
was to make the state governments realise their own responsibilities to
set up an effective STC to run the TB programme of the state. Thus, the
NTI replaced the regular training course into the Trainers Training Programme
of eight weeks duration; the first one was started on 8th January 96
from which participants of nine states benefited. It was also attended
by two MOs from Myanmar and one para medical from Nepal. It was expected
that the well equipped STCs will start the training courses for the DTC
key personnel. In actuality none of the STCs could do so. Eventually NTI
resumed the regular training courses after an interval of two years as
the gap between trained and untrained staff started widening at DTCs.

81st Training Course, January - March 1999 |
The fact that the NTP has not succeeded so far
in fulfilling the difficult mission, does not justify adopting easy
postures that betray an escapist tendency. For e.g., the DTOs must
realise that a very good district clinic under the DTP can never
substitute a set of well distributed and well implemented PHIs functioning
under adequate supervision. Moreover, a good physician at a central
clinic is less of a necessity than a good organiser and supervisor
of the programme activities in the context of the DTP. Similarly,
research studies revealed that the urban aspects of the problem
is of much lower priority in comparison with the rural ones. Though
a lot has changed since the NTI started its researches and recommended
a programme, the basic problem continues to remain unaltered. It
is, however, necessary to take care of both kinds of reactions mentioned
above: the one of resignation and the other of misutilisation of
energy and material resources.
Editorial, NTI Newsletter June 1980, Vol 17/2, 36
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