Agra Presentation

8/3/2019 Agra Presentation

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Revised National TB Control

Programme (RNTCP)

PPM DOTS in RNTCP

Central TB Division,

Ministry of Health and Family Welfare

Government of India


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Problem of TB in India

Incidence of TB disease: 1.8 million new TB cases annually (0.8

million new infectious cases)

Prevalence of TB disease: 3.8 million bacteriologically positive

(2000)

Deaths: about 370,000 deaths due to TB each year

TB/HIV: ~2.5 million people with HIV;

About 5% of TB patients estimated to be HIV positive

MDR-TB in new TB cases 3%

Substantial socio- economic impact


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0

200

400

600

800

1000

1200

Qtr1-94

Qtr3-94

Qtr1-95

Qtr3-95

Qtr1-96

Qtr3-96

Qtr1-97

Qtr3-97

Qtr1-98Qtr3-98

Qtr1-99

Qtr3-99

Qtr1-00

Qtr3-00

Qtr1-01

Qtr3-01Qtr1-02

Qtr3-02

Qtr1-03

Qtr3-03

Qtr1-04

Qtr3-04

Qtr1-05Qtr3-05

Qtr1-06

Qtr3-06

Quarter/Y

ear

Population covered (millions)

Total

patien

ts

treated

Popula

tion

co

ver

age(inmillion

s)

Po

pula

tionin

India

cov

ere

dun

derD

O

TSan

d

Tub

erculo

sisP

atien

tsputon

treatmen

teach


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Annualized New Smear-Positive Case Detection Rate

and Treatment Success Rate in DOTS areas, 1999-2007

Population projected from 2001 censusEstimated no. of NSP cases - 75/100,000 population per year (based on recent ARTI report)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Qtr1-99

Qtr2-99

Qtr3-99

Qtr4-99

Qtr1-00

Qtr2-00

Qtr3-00

Qtr4-00

Qtr1-01

Qtr2-01

Qtr3-01

Qtr4-01

Qtr1-02

Qtr2-02

Qtr3-02

Qtr4-02

Qtr1-03

Qtr2-03

Qtr3-03

Qtr4-03

Qtr1-04

Qtr2-04

Qtr3-04

Qtr4-04

Qtr1-05

Qtr2-05

Qtr3-05

Qtr4-05

Qtr1-06

Qtr2-06

Qtr3-06

Qtr4-06

Qtr1-07

Qtr2-07

Qtr3-07

Qtr4-07

Annualised New S+ve CDR Success rate


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Year Milestones

1993 RNTCP started in pilot districts

1995 PPM model started in Hyderabad (NGO Hospital)

1997 National consensus conference of Medical Colleges

2000-2003 PPM models in Delhi, Kannur, Kollam, Mumbai, Tea-gardens of north-east

2001 Schemes for involvement of NGOs in RNTCP published

2002 Schemes for involvement of Private Practitioners (PP) in RNTCP published

2002 National workshop of medical colleges: seven nodal centres identified

2002-2003 PPM activities initiated in all the RNTCP states

2003 Intensified PPM scaling up began in 12 urban sites

2003-2004 Initiatives to involve other Government Departments, Public Sector Undertakings

2004 Declaration by national IMA to support RNTCP

2005 IAP guidelines, Urban DOTS GFATM projects, expansion of intensified PPM

2007 17,000 private practitioners, 250 Medical colleges, 2500 NGOs and 150 corporatehouses involved

RNTCP: Major milestones in PPM DOTS


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The New Global Strategy to Stop

TB


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Public-Private Mix (PPM) DOTS

PPM DOTS is a strategy to diagnose and treat

TB patients reporting to all sectors of health care

under DOTS strategy through a mix of differenttypes of health care service providers

PPM DOTS has been defined by WHO as

strategies that link all entities within the

private and public sectors (including healthproviders in other governmental ministries)

to the national TB programme for DOTS

expansion.


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ISTC

Focuses on TB care aswell as control

Supported by a broadinternational consensus

Presents an evidence

base Applies to all

practitioners and ismore relevant to theprivate sector

Serves as a focus of aglobal campaign toimprove TB care andcontrol


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Public sector

Provides

training/supervision

drugs/supplies/honorariu

m Notifies TB cases

Retrieves patients who

interrupt treatment

Other sectors

Refer/Diagnose/treat TB cases

Inform public sector about

TB patients/interruption of treatment

Follow

RNTCP guidelines

NGO/PP guidelines

Roles of public and private sectors in

PPM DOTS


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Achievements in PPM

3000 NGOs involved under RNTCP

~17,000 Pvt. practitioners involved under RNTCP

261 Medical Colleges following DOTS strategy

150 Corporate Houses participating in RNTCP

Involvement of professional bodies

IAP involved in development of Pediatric guidelines 2005

IMA actively collaborating in 167 districts/ 6 states under Rd 6

GFATM Project Indian Medical Professional Association Coalition against TB

(IMPACT) established in March 2007


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Intensified PPM DOTS sites

14 intensified PPM sites

Pilot Site State

Ahmedabad Gujarat

Bangalore Karnataka

Bhopal Madhya

Pradesh

Bhubaneswar Orissa

Chandigarh Chandigarh

Chennai Tamil Nadu

Delhi Delhi

Jaipur Rajasthan

Kolkata West Bengal

Lucknow Uttar Pradesh

Patna Bihar

Pune Maharashtra

Ranchi Jharkhand

Thiruvanthapura

m

Kerela* Additional sites


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14 intensified urban PPM districts( 3rd qtr2006 to 2nd qtr2007): Summary of

Contribution by different health sectors

61.2% 61.9%64.6%

71.8%

4.8%3.6%

3.5%

25.7% 24.5% 18.0% 5.9%

8.6%

5.8% 7.2% 7.0%11.5%

1.8%

0.3%

0.2%0.2%0.4%

5.2% 2.5% 6.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

TB suspects referred All S+ cases diagnosed New S+ cases detection No. of Patients provided

DOT

Health dept Govt, other than health Medical Colleges Corporate Private NGO

N=35658 N=49674 N=26321 N=76028


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Initiatives to Involve Medical Colleges

Consensus conference held 1997

Workshop of professors 2001

Workshops in States / Medical Colleges from 2002 onwards

National/Zonal/State Task MC

Forces created

Core Committees in MCs

RAJASTHAN

ORISSA

GUJARAT

MAHARASHTRA

MADHYA PRADESH

BIHAR

KARNATAKA

UTTARPRADESH

ANDHRAPRADESH

JAMMU &KASHMIR

ASSAM

TAMIL

NADU

CHHATISGARH

PUNJAB

JHARKHANDWEST

BENGAL

HARYANA

KERALA

UTTARANCHAL

ARUNACHAL PRADESH

HIMACHAL PRADESH

MANIPUR

MIZORAM

MEGHALAYA

NAGALAND

TRIPURA

SIKKIM

GOA

A&N ISLANDS

D&N HAVELI

PONDICHERRY

LAKSHADWEEP

DELHI

West Zone

East Zone

South Zone

North Zone

North-East Zone

ORISSA

#

#

#

#

#

#

#

Guwahati

Kolkata

Vellore

Chandigarh

AIIMS,Delhi

Jaipur

Mumbai

Medical Colleges as

RNTCP Nodal centres

RG Kar Medical College, CalcuttaLokmanya Tilak Municipal Medical College and Hospital, MumbaiSMS Medical College, Jaipur

All India Institute of Medical Sciences, N DelhiPost Graduate Institute of Medical Education and Research, ChandigarhChristian Medical College, Vellore, Tamil NaduGuwahati Medical College, Guwahati, Assam


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PPM DOTS

Systematic process in involvement Sensitization of administrators and opinion leaders

Orientation of RNTCP staff on PPM DOTS

Listing of PPM health care providers Identification/verification of PPM facility

Sensitisation of PPM providers

Training of PPM providers Signing of RNTCP schemes (Memorandum of Understanding-

MoU)

Start of service delivery


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Tools for PPM DOTS


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RNTCP guidelines

for the involvement

of NGOs (2001)


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RNTCP PPM DOTSadvocacy kit (2005)


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Training module for

private medical practitioners

Concise module

6 hours training

1 day X 6 hours

2 days X 3 hours

3 days X 2 hours


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Involvement of NGOs in RNTCP

There are 5 Schemes for collaboration

with NGOs

Scheme 1- Health education & community

outreach

Scheme 2- Provision of DOT

Scheme 3- In-hospital care for TB disease

Scheme 4- Microscopy & Treatment centre

Scheme 5- TB unit model


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PP schemes

1. Referral services

2. Provision of Directly Observed Therapy

3a. Designated Paid MC microscopy only.3b. Designated Paid MC microscopy and

treatment.

4a. Designated MC microscopy only.

4b. Designated MC microscopy and treatment.


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NGO Involvement in RNTCP in India

(year wise)

NGO

150

300

512

1222

2046

2263

0

500

1000

1500

2000

2500

2001 2002 2003 2004 2005 2006


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PP Involvement in RNTCP in India

(year wise)

PP

500900

1500

5518

10714

14674

0

2000

4000

6000

8000

10000

12000

14000

16000

2001 2002 2003 2004 2005 2006


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NoofNGOs

264 261

238

214207

166

131

114 10598

92

69 67 63 61 57 56

0

50

100

150

200

250

300

Ma

haras

htra

Gujarat

Tam

ilNa

du

Uttar

Pra

desh

Punjab

Karna

taka

Rajas

than

An

dhra

Pra

desh

Wes

tBengal

De

lhi

Man

ipur

Jhark

hand

Bihar

Assam

Kera

la

Orissa

Ma

dhya

Pra

desh

State*-wise distribution of NGOs

(3rd qtr2007)

*Only states with more than 50 NGOs involved are presented in the slide


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State*-wise distribution of PPs

(3rd qtr2007)

NoofPPs

4736

4307

1385

1006 972

730686

469391 353 346 305 280 256 231 195 169

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

Gujarat

Maharashtra

Karnataka

Kerala

TamilNadu

Punjab

UttarPradesh

Rajasthan

Delhi

Haryana

WestBengal

MadhyaPradesh

AndhraPradesh

Assam

Chhatisgarh

Chandigarh

Bihar

*Only states with more than 150 PPs involved are presented in the slide


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Challenges - PPM DOTS

Public sector related Lack of interest / experience in dealing with other sectors

Lack of faith in the capacity of private sector

Private practitioner related Large and unorganized private sector Lack of faith in Public sector health programmes

Low priority for carrying out public health programmes

Patient related Contradicting information from health sectors/systems Lack of trust in the quality of care provided by public sector

Issues of stigma and confidentiality

Documents

Agra Presentation