Health problems in India form only a small part of the large variety of pressing socio-economic problems that face the community. Pulmonary tuberculosis, among the health problems, is one of the many problems which need immediate attention. In the resources that are available for dealing with the different problems, the share which could be given to tuberculosis could not be big. If, due to some special reasons, a disproportionate slice of the resources is used up in applying advanced technological methods to satisfy a fraction of the total needs of the community, other problems may be accentuated. Logically a solution of the tuberculosis problem in India should form an integral part of a comprehensive overall social development plan for the community. If the tuberculosis control programme is according to the felt need, generated by the disease in the community, it would be in consonance with the other health and social programmes evolved for dealing with the other felt needs. Available information shows that it is possible to develop a minimal nation wide tuberculosis casefinding and treatment programme through the general health services. If the available resources in the future improve, then a corresponding qualitative and quantitative improvement in the working of the tuberculosis programme could be easily affected. It also appears reasonable to expect such a programme to produce an impact on the epidemiology of the disease.

The problem of tuberculosis in a developing country such as India must be considered in the overall social and economic context. Massive investment of money and resources to eradicate tuberculosis may interfere with other measures more important for the country's progress. But a limited investment in a suitably oriented tuberculosis programme could hasten the decline of the disease. Social planners thus face a special challenge in such countries. The problems are almost over whelming, while the resources available are extremely limited; scientists will have to formulate programmes which will ensure that these resources are utilised to give a maximal return from the investment. Thus, in considering tuberculosis as a problem of social planning in developing countries it will have to be dealt with at three different levels:

(a) Recognising the implications of factors other than a specific tuberculosis programme on the incidence of the disease; (b) devising methods that could offer the best possible returns from the available resources, both at any given point of time as well as at different time intervals; and (c) determining priority for allocating resources in a socially applicable tuberculosis programme. The National Tuberculosis Institute, Bangalore has used operational approach for formulating a nationally applicable and acceptable tuberculosis programme for India. The sequence of steps that led to the formulation of tuberculosis programme in India can as well be applied to develop a similar programme in any developing country.

There is no generally acceptable definition for developing countries. On account of multiple demands of varying urgency on small resources, public health often receives lower priority than it deserves. To change the equilibrium between man and bacilli in the direction of positive health it would be necessary to invest resources on many key factors. Control of tuberculosis can only be a part of the effort to achieve the positive health. It is also now known that undue importance to quick conversion of sputum or early return of patients to work, need not be given. But the objective of TB programme for developing countries should be i) not to neglect service to actual sufferers and ii) to apply specific control measures in harmony with measures aiming at the overall improvement of socio economic conditions.

For developing countries domiciliary chemotherapy is the treatment of choice. Applying chemotherapy on a long term basis poses many problems, the main being the fall out of patients from treatment. The key factors are: a practical and economically feasible Case-finding and treatment programme, an adequate supply of anti TB drugs and effective executive cum supervisory organization. The District Tuberculosis Programme for a population of 1-1.5 million in each district, comprises one specialised district TB Centre which makes use of the area general health services for tuberculosis Case-finding and treatment. Several stages of development are envisaged and a start can be made from any stage, according to the facilities already available. The emphasis is on providing treatment for the patients nearest to their homes, along with effective supervision exercised by general health services staff under the guidance of the district centre. The choice of a drug regimen in the programme will depend upon efficacy of the regimen, availability of drugs, average cost of treatment, suitability for self administration and acceptability by patients/organisation. INH+PAS daily or supervised streptomycin containing intermittent regimen for smear positive cases, INH alone daily for sputum negative appear to be the regimens of choice for developing countries. It is unfortunate that a powerful regimen like S + H + PAS is very expensive and less acceptable. Thus a planned and systematic approach is needed to deal with the problem of TB. For running an organised and coordinated tuberculosis control programme, the national character of the Campaign should be recognised right at the start and maintained till the objective has been achieved.

It has been shown that most of the infectious tuberculosis cases in a rural community in south India are at least conscious of symptoms of the disease; about three fourths of them are worried about their symptoms and about half are seeking relief at rural medical institutions. It is well known that the existing facilities deal with only a very small fraction of even those patients who are actively seeking treatment. India's National Tuberculosis Programme has been designed to mobilise the existing resources in order to offer suitable diagnostic and treatment services to those who already have felt - need. India's health administrators have to initiate suitable administrative and organizational reorientation of the existing medical and health services to satisfy this already existing felt needs. The more provision of such services could very well motivate the remaining tuberculosis patients to seek the help from the medical institutions. This motivational force is expected to get reinforced as a result of progress in the field of education, mass communication, transport and industrial and agricultural production. Simultaneously, progress in the social and economic plans will offer the needed resources for strengthening the existing health services in terms of personnel, funds, equipments and supplies. Further more, social and economic development, by increasing awareness of the population, will ensure a more effective utilization of the existing services. Thus, social and economic growth will not only help in the development of an epidemiologically effective tuberculosis control programme, but the very rise in the standard of living itself might make a significant impact in controlling the disease in the country.