I am sure that all of you are familiar with the classic studies showing the relative sensitivity and specificity of sputum microscopy and chest X-ray. By now I hope you have ensured that each and every patient in the OPD of your institution is asked if they have cough for 3 weeks, and, if they do, that they undergo 3 sputum examinations. We all learn about the cough reflex in medical school. We should be promoting and establishing a “sputum reflex” in our doctors – 3 weeks cough, 3 sputum examinations. We should be establishing a culture of sputum smear examinations.

A key thrust area of the programme for its continued success is to involve all large providers of care. In this direction, GOI has undertaken several initiatives to solicit the involvement of medical colleges. Sensitization of medical college professors, direct interaction with medical colleges by local programme managers and consultants, several communications from TB division as well as personalized letters from me have been undertaken. In March 2001, I personally wrote to the Deans of more than 100 medical colleges urging their full participation in the RNTCP. A National Consensus Conference was held in 1997, which was attended by a large number of leading medical colleges from all over India and included the active participation of Sir John Crofton. The conference passed a resolution that “…. phased and effective implementation of RNTCP is the best strategy and perhaps the only chance of controlling TB in India during this generation”.

There is now a growing professional consensus among public health and medical opinion leaders alike that the recommended approach is appropriate and feasible. In fact, although this was still very much in question just a few years ago, given the remarkable success of recent years, there can no longer be any doubt. The RNTCP is not only practicable on a mass scale in India, but, much more remarkably, it is actually being practiced on a mass scale! The challenges now are to correct any weak areas, and to continue to expand coverage so that the entire country can be covered.

Many medical colleges are now participating in the programme as TUs, MCs, treatment observation centres, etc. In fact, I am very pleased to note that, following my letter of March 2001, there are now more than 30 medical colleges which are providing RNTCP services. I am sure that each and every of your institutions, if it is not already providing care, will begin doing so soon.

To co-ordinate the activities of RNTCP in medical colleges, GOI is providing supportive staff on contractual basis wherever required, as well as commodity assistance for laboratory and treatment services. On the part of the colleges, we request that diagnosis and treatment of TB be standardized. The recommended diagnostic algorithm and treatment categorization should be followed. Professors may not only teach the principles of DOTS but set examples by practicing it.