Revised National TB Control Programme

1. Revised National TB Control Programme

2. District/sub-district analysis All States Specific actions included in Annual Action plan Universal Access for TB Care Major discussion point in STO’s Biannual Review meeting conducted from 29th to 31st January 2010. CTD developed a Guide to programme managers on Universal access for TB care. Link Priority activities identified by states to increase case detection were reviewed in the STO/Consultants review meeting on 17th and 18th June 10 Action taken Report on the minutes of State Health Secretaries Meeting 15th/16th January 2010- cont..

3. Action taken Report on the minutes of State Health Secretaries Meeting 15th/16th January 2010- cont.. • Human Resources: • Still continues as an important issue in most of the states. • STO • STC • DTO • Additional contractual posts (Asst programme officer/ Epidemiologist (1per state), DOTS-Plus site MO(1/site), DOTS-Plus site SA(1/site), Sr. LT at IRL (1 per IRL), Store Assistant (SDS) (1 per SDS) , DEO (IRL) (1 per IRL), Sr. DOTS Plus and TB HIV Supervisor (1 per district) • 4 states- Gujarat, West Bengal, Delhi and Haryana has appointed. • Tamil Nadu, Orissa, Bihar, Uttar Pradesh and J&K has not initiated any actions • Other states are at various stages of procurement

4. Action taken Report on the minutes of State Health Secretaries Meeting 15th/16th January 2010- cont.. • Training Status under RNTCP. • Review of the training status done during the STO/Consultants meeting in January 2010 • Detailed plan was prepared by states to strengthen the training activities. • Incorporated in the annual action plan. • 30% of the trainings planned for the year 2010-11 have been completed by June 2010. • STOs were advised to follow the training plan.

5. Action taken Report on the minutes of State Health Secretaries Meeting 15th/16th January 2010- cont.. • Strengthening the supervisory activities at all levels • States have reported improved supervisory visits, reviews and Internal evaluations. Link • Strengthening involvement of General Health system: • GOs to ensure that CMOs review RNTCP, • Govt MO don’t prescribe TB drugs outside the programme • 9 states already issues GOs (Kerala, Karnataka, UP, MP, Rajasthan, Gujarat, Andhra Pradesh, Mizoram and Uttarakhand) • Other states-under process.

6. Universal Access to TB Care

7. NSP Case Detection Rate (%) 1Q2010 1Q2009 National Level- 70% National Level- 70% > 70%, 255 > 70%, 260 50% - 69.9% 263 50% - 69.9% 231 30% – 49.9% 114 30% – 49.9% 133 < 30% 21 < 30% 16

8. Steps to Universal access • Most of the un-notified cases are seeking health care but not being captured by the system. • They can be reached by • Increasing suspects examination rate • National level- 160/lakh/qtr • District level- wide variations • Ensure adequate infrastructure • DMCs-trained LTs • TUs • Sputum collection and Transport facilities • Medical Colleges • Involving all departments in Medical Colleges • Strengthening Supervision and Monitoring • Filling up of vacant posts • Proactive programme review at all levels • Implementing Tribal Action Plan

9. Steps to Universal access • Other Health Care providers • Other Govt health sectors, corporate sector, ESI, Mines etc • NGO/PP involvement • IMA, CBCI • GF Rd-9 Project- • ACSM-374 district • IUATLD- (300 districts) • World Vision-(74 districts)

10. Steps to Universal access • Contact Tracing • Contact tracing of sputum positive patients • Intensified case finding activities in High risk population • HIV • Smokers • Diabetes • Linking with Anti-natal care services • Mothers • Child

11. Delays in preparations for initiating MDR TB services

12. Delays in preparations for initiating MDR TB services

13. Finance • Financial Status • Commodity Assistance

14. Thank You

15. States with no full time STO

16. Stateswith no full time STO cont.. Back

17. State wise vacancies at State TB Cell

18. State wise vacancies at State TB Cell.cont.. Back

19. Positions of District TB Officers * These district TB officers hold multiple other charges and/or are just in-charge

20. Positions of District TB Officers * These district TB officers hold multiple other charges and/or are just in-charge Back

21. Key Staff Positions – Vacant, Untrained – 1Q10 BACK

22. State Level RNTCP Reviews in 2009/1st qtr 2010

23. State Level RNTCP Reviews in 2009/1st qtr 2010-cont.. Back

24. Internal Evaluation by States in 2009 – 1q10

25. Internal Evaluation by States in 2009 – 1q10 Back 19 states/30 districts SIE conducted in 1Q10

26. Issues in TB HIV Co-ordination TB HIV Coordinators not appointed in many states eg. Bihar, HP, Jharkhand, Chattisgarh, Kerala District co-ordination committees not formed in many districts of Bihar and MP Joint supervisory visits by STC & SACS to districts not happening in many states. Expediting district level trainings in Intensified TB/HIV Package in the preparatory states (Rajasthan, Kerala, Assam, WB, Orissa, Punjab and Chandigarh) Expediting state level trainings in Intensified TB/HIV Package, procurement of CPT pouches and printing of modules and registers/referral forms in the newly launched states (UP, MP, Haryana, HP, Uttarakhand, Chattisgarh, Jharkhand, Sikkim, Tripura, Arunachal Pradesh and Meghalaya) Key challenge is to bridge the gap at service delivery level between RNTCP and NACP – By co-locating existing ICTCs and DMCs (AP & Karnataka: In about 33% of the DMCs, ICTC is not co-located. Maharashtra: 65% of the DMCs, ICTC is not co-located) By establishing Facility integrated ICTCs and roll-out of Whole blood testing for HIV. The linkage of the HIV positive TB patients to ART centres is weak in many states and needs to be strengthened. Back

27. TB Suspects examined per 100,000 population by district, India First Quarter, 2010 AS AR AP BI CG DL GA GU HR > 188, 174 districts, (162 in 1q09) 150 – 187.9, 166 districts (158 in 1q09) 110 – 149.9, 155 districts (173 in 1q09) Back < 110, 158 districts (147 in 1q09) HP JK JH KA KE MP MH OR PJ RJ TN UP UT WB

28. Jharkhand NSP Case Detection rate 1q09-1q10 State level – 1q09 NSP CDR (2009)-71% NSP TSR (2008)-89% State level – 1Q 10 NSP CDR (1Q10)- 74 % NSP TSR (1Q09)- 89 % Good Moderate Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80% Poor

29. Jharkhand Suspects examination rate 1q09-1q10 Poor <110 Below Average110<150 Fair 150-<188 Good 188>

30. Jharkhand Back

31. Gujarat NSP Case Detection rate 1q09-1q10 State level – 1Q 09 NSP CDR (2009)-76% NSP TSR (2008)-87% State level – 1Q 10 NSP CDR (1Q10)- 75 % NSP TSR (1Q09)- 87 % Good Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80% Moderate Poor

32. Gujarat Suspects examination rate 1q09-1q10 Poor <110 Below Average110<150 Fair 150-<188 Good 188>

33. Gujarat Back

34. Bihar NSP Case Detection rate 1q09-1q10 State level – 1Q 09 NSP CDR (2009)-41% NSP TSR (2008)-88% State level – 1Q 10 NSP CDR (1Q10)- 49 % NSP TSR (1Q09)- 90 % Good Moderate Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80% Poor

35. Bihar Suspects examination rate 1q09-1q10 Poor <110 Below Average110<150 Fair 150-<188 Good 188>

36. Bihar

37. BIHAR • Rate contract for laboratory consumables not finalized since June 2008. Regular shortage of consumables in all districts • All state level contractual posts vacant • No Deputy STO or MO-STC . STO has multiple charge • No printing done in the state for the last 2 ½ years. Shortage of all recording and reporting formats. Districts resorting to photocopying • Delay in Contract renewal , payment of remuneration and reimbursement of POL to contractual staff varying from few months to a year. • Although 200 laboratory technicians appointed in February 2010 by state health society, only 14 were trained for RNTCP lab work at state level. • DOTS PLUS committee not yet formed Back

38. Andhra Pradesh NSP Case Detection rate 1q09-1q10 State level – 1Q 09 NSP CDR (2009)-79% NSP TSR (2008)-88% Good Moderate Poor State level – 1Q 10 NSP CDR (1Q10)- 78 % NSP TSR (1Q09)- 89 % Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR 50 – 69.9% and/or NSP TSR 80 – 84.9%; Poor = NSP CDR < 50% and NSP TSR < 80%

39. Andhra Pradesh Suspects examination rate 1q09-1q10 Poor <110 Below Average110<150 Fair 150-<188 Good 188>

40. Andhra Pradesh Back

41. Arunachal Pradesh NSP Case Detection rate 1q09-1q10 State level – 1Q 09 NSP CDR (2009)-87% NSP TSR (2008)-86% State level – 1Q 10 NSP CDR (1Q10)- 75 % NSP TSR (1Q09)- 86 % Good Moderate Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80% Poor

42. Arunchal Pradesh Poor <110 Below Average110<150 Fair 150-<188 Good 188> Suspects examination rate 1q09-1q10

43. Arunachal Pradesh Back

44. Assam NSP Case Detection rate 1q09-1q10 State level – 1Q 09 NSP CDR (2009)-67% NSP TSR (2008)-88% Good (7 districts) State level – 1Q 10 NSP CDR (1Q10)- 72 % NSP TSR (1Q09)- 85 % Moderate (16 districts) Poor (1 district) Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80%

45. Assam Poor <110 Below Average110<150 Fair 150-<188 Good 188> Suspects examination rate 1q09-1q10

46. Assam Back

47. Chhattisgarh NSP Case Detection rate 1q09-1q10 State level – 1Q 10 NSP CDR (1Q10)- 68 % NSP TSR (1Q09)- 88 % Good (3 districts) Moderate (11 districts) State level – 1Q 09 NSP CDR (2009)-53% NSP TSR (2008)-87% Poor (2 districts) Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80%

48. Chhattisgarh Poor <110 Below Average110<150 Fair 150-<188 Good 188> Suspects examination rate 1q09-1q10

49. Chattisgarh Back

50. Delhi NSP Case Detection rate 1q09-1q10 State level – 1Q 09 NSP CDR (2009)-91% NSP TSR (2008)-87% State level – 1Q 10 NSP CDR (1Q10)- 84 % NSP TSR (1Q09)- 86 % Good (4 districts) Moderate (10 districts) Good = NSP CDR >= 70% and NSP TSR >= 85%; Moderate = NSP CDR > 50% and/or NSP TSR > 80%; Poor = NSP CDR < 50% and NSP TSR < 80% Poor