The article examined the social dimensions of the NTCP and social issues inside and outside the health service system. The NTCP had initiated and advocated the use of symptoms as the basis for making the preliminary diagnosis, the use of people's felt-need as a basis for a passive case detection strategy through GHS and, provided home treatment instead of the earlier institutional therapy. The important social issues inside the health service system that affected the implementation of NTCP were: 1) Other communicable disease control programs did not use the social approach resulting in consumption of huge resources, 2) Precedence was given to family planning and malaria eradication. This was a frank distortion in the social nature of planning. The outside social issues identified in the paper were the problem of default due to poverty and uncontrolled interventions by the private sector.

The problem of TB 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 TB may interfere with other measures more important for the country`s progress. But a limited investment in a suitably oriented TB programme could hasten the decline of the disease. Social planners thus face a special challenge in such countries. The problems are almost overwhelming, 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 TB 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 TB programme on the incidence of the disease; (b) developing 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 TB programme. The NTI, Bangalore has used operational approach for formulating a nationally applicable and acceptable TB programme for India. The sequence of steps that led to the formulation of TB programme in India can as well be applied to develop a similar programme in any developing country.

With the introduction of effective TB drugs, the importance of the outpatient-clinic in relation to that of the hospital, concerning treatment, has suddenly increased. Some of the social problems attaching to the out-patient care of TB are: 1) maintaining patients under supervision for long periods of time, 2) the problem of irregular drug-taking (the major reason for failure to take medicines were found to be laziness and indifference on the part of the patient), 3) some patients encountered obstacles (financial, emotional, social or other) which prevented them from following instructions. Special problems are encountered in special groups of patients: the aged, the emotionally unstable, the sociopathic, the alcoholic, the young. All of the above- mentioned social problems are discussed in detail.

Using the data of the National TB Register, and reports from the Satakunta sanatorium, Finland, it was shown that the educational and occupational levels of new cases of TB among persons of more than 50 years of age remained comparatively unchanged in Satakunta during the period 1954-1969. In comparison with the total population of the same age in 1960, aged TB patients had a lower educational and occupational status. The level of housing of tuberculotic patients was found to be about the same as the total population in 1960. During the same period, the incidence of TB among those of 50 years and above did not change noticeably, whereas a complete change was observable with regard to the situation of younger age groups. In the current situation, with the influence of recent infection being practically excluded, it appears that the incidence of TB in old age cannot be influenced by purely social action, for example, by improving the level of housing. Instead, priority should be given to medical treatment.

A comparison of incidence rates and hospital utilization rates of the aged indicates that these two phenomena are almost parallel. This similarity lends support to the concept that patients have been hospitalized mainly for medical reasons. The occupational status of new cases of TB and discharged patients remained almost the same for a decade. This further indicates that social conditions were not decisive in the selection of patients for care. Not until after the mid-sixties did the aged attain the level of utilization of hospital services which could be anticipated on the basis of morbidity rates. A rough forecast is made of the estimated development in the near future: the number of persons of more than 50 years of age in 1980 would be about 80 percent of hospitalized patients.

The article provides a description of the health facilities including medical manpower available in India in the mid-60s. Given that the population was rising by 2.2% per annum, it was suggested that the social and sociological significance of the increase of TB morbidity be considered in relation to population growth. Since the Indian tubercle bacillus, while less virulent, varied from strain to strain considerably more than in the European countries, it was recommended that devising ways to combat TB be based on the specific needs of the country. Over Rs. 2,000 crores per annum was expected to be needed to combat TB in India. Therefore, it was more cost- effective to expend funds in the prevention and control of TB rather than used towards covering the cost of illness and premature death.

TB control was one of the priority items in the National Health Programmes incorporated in the successive Five-Year Plans covering 30 years. On reviewing the earlier history of TB Services in India, it was evident that, while the prevalence of TB was recognised in India from 2,500 B.C., the awareness of its existence as a major problem only occurred in the early part of this century. The establishment of the TAI in 1939 marked the first national voluntary effort and also when domiciliary treatment for TB patients was first offered. The break out of the Second World War and the aftermath of the partition of India in 1947 brought all nation-building efforts to a standstill. Subsequently, in 1948, the Indian Government set up a separate TB Section in the DGHS, encouraging rededication to providing TB services; at the same time antibiotics began to replace the use of pneumo-thorax treatment. By the mid-60s, the TB control programme in India covered wide-ranging activities such as Preventive Services, TB Clinics, Hospitals & Sanatoria, Rehabilitation, Research and Health Education. The emphasis was on providing preventive & clinical services and domiciliary, anti-microbial activity. A description of various other anti-TB measures taken by governmental, voluntary and international agencies completes the review.

The success of the entire treatment program for the patient with TB or other long-term illness lies not only with the attending physician and nurse but also with the occupational therapist. The human problems that can be benefited by occupational therapy can be physiologic, psychological or both. To be most effective, occupational therapy must offer a program of activity to meet the orders in the prescription and to help the patients overcome the deficient factors themselves. The range of activities used in occupational therapy is as broad as the needs and the interests of the patients (example, developing a scrapbook for one who has to have absolute bed rest; specific work-outs for those whose muscles have become flaccid; vocabulary building, spelling and arranging for studies within the intellectual capacities of young patients whose education was interrupted by illness), the facilities available and the ingenuity and the initiative of the therapist. Likewise, occupational therapy for young children helps them adjust to life in the hospital,, improve adverse, psychological reactions and reduces behavioural problems. For adolescents, their interests are directed toward vocational training and often, actual training is initiated in the occupational therapy programme. Occupational therapy can dramatically shorten convalescence and improve the degree of recovery in patients.