The practice of three sputum smear examinations as a primary diagnostic tool for pulmonary TB should be promoted and established. All departments of the medical colleges should be sensitized to the programme, and activities within the hospital co-ordinated to ensure that each and every adult outpatient is asked about cough, and that all persons with cough for 3 weeks or more undergo 3 sputum examinations at the designated laboratory. This should be widely publicized throughout all OPDs of the medical colleges through posters, etc.

Diagnostic algorithm of the RNTCP is based on a sound technical rationale and should be followed as a standardized means of diagnosing TB patients.

RNTCP regimens are effective when categorization of patients is made accurately as per guidelines and direct observation of treatment is ensured. The treatment practices followed in medical colleges should thus be standardized to conform to RNTCP principles and guidelines.

All rifampicin-containing regimens should be directly observed in the intensive phase.

Procedures for referring patients from hospitals to peripheral facilities should be strengthened. A directory providing information of RNTCP facilities within the district should be made available by each DTO to the designated authority of every medical college in the area in order to facilitate appropriate referrals of patients. The hospital should assign one person with the responsibility for ensuring effective referral and for tracking the effectiveness of the referral process in close co-ordination with the District/State TB officials. Peripheral facilities are responsible for providing feedback information to the hospital and ensuring that patients referred by the hospital receive appropriate and complete treatment.