Serious implications of the proposed revised national tuberculosis control programme for India. Voluntary Health Association of India, Nucleus for Health Policies and Programmes. VHAI, New Delhi, 1997. pp. 100

When the National TB control programme was set up in 1962, it was lauded as one of the few research-based efforts with epidemiological data, longitudinal studies, effficacy studies. It was devised after identifying the factors that influenced health service usage, and linked to a model of primary health care.

Yet more than 25 years later, over 14 million Indians suffer from TB, and over 500,000 die of it every year. A 1992 government study found that less than 30 per cent of diagnosed TB patients complete their drug course. Inadequate budgets, chronic drug shortages, an undue emphasis on x-ray diagnosis, poor quality of sputum microscopy, emphasis on case detection rather than cure, poor organisational set-up and support, and a multiplicity of treatment regimes, not conforming to the WHO’S standards – all of this contributed to the programme’s failure.

This did not seem to concern the government – till the HIV pandemic woke the West up to the fact of HIV-related TB, and the possibility of multi-drug resistant

The Revised National TB Programme focusses on a very different perspective from the earlier programme. The Directly Observed Treatment programme, which worked to control TB among poor people in urban USA, is going to be implemented “in the deserts of Rajasthan…(and) the forests ot’Gadchirolli”, in an effort to bring the disease “under control”. The programme will be supported by international grants and ‘soft loans’ from the World Bank.

It was following stiff criticism of this new approach that the Voluntary Health Association of India commisioned the Nucleus for Health Policies and Programmes to prepare a rejoinder to the draft RNTCP. Assisted by an authoritative advisory committee, Debabar Banerji prepared a position paper on the proposed revised programme focussing on DOT.

The paper was circulated to a number of organisations dealing with the subject – including the World Bank, which actually responded by coming to India for a meeting with the group.

“Serious implications…” presents a succinct overview of the TB control programme in India – its epidemiological basis and link to a people-based health service, problems with its implementation, and international initiatives. A short description by the government of the current and revised strategy is followed by the authors’ critique, and their alternative plan for action.

The bibliography is followed by a series of annexures that delineate the process that followed the critique. In March 1996, key institutions and scholars were contacted for their comments; the text of those who responded is reproduced, along with comments from the authors; the minutes of a meeting with the World Bank / WHO is described, along with the Bank’s correspondence on those minutes.

Finally, there is the Indian government’s official memorandum on a national coordinating committee to plan, implement and evaluate the revised programme.

This package provides a useful picture of the issues involved in theTB control programme.

Short notes

The Marathi publishing house Granthali released two books by doctors last month.

In Manoos navache jagane (A living called human being), plastic surgeon Ravin Thatte details the personal influences of the philosopher Dyaneshwar. DrThatte said he wrote the book in response to the several questons about life and death which surrounded me” while working as a doctor.

In Aushadh ani aapan (Medicines and us), Sharadini Dahanukar maps the history of modern medicines, their making and side-effects.