Revised National Tuberculosis Control Programme PublicPrivate Mix PPM

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Revised National Tuberculosis Control Programme
Public-Private Mix (PPM) Workplace DOTS in
India

• Central TB DivisionMinistry of Health Family
  WelfareNew Delhi

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RNTCP Major milestones in PPM DOTS

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Tools for PPM DOTS
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RNTCP guidelines for the involvement of NGOs
(2001)
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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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RNTCP guidelines for the involvement of private
practitioners (2002)
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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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RNTCP PPM DOTS advocacy 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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Progress in 2007

• 17283 private practitioners involved
• 2482 NGOs involved
• About 250 medical colleges involved
• gt150 corporate houses involved
• GFATM IMA project launched in six states
• Launching of IMPACT (Indian Medical Professional
  Association Coalition against TB)

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Intensified PPM project in urban areas

• Objective To increase the proportion of TB
  cases being diagnosed and treated under DOTS
  strategy through systematic involvement of all
  types of health care providers and documentation
  of the processes and outcomes
• Started in 14 districts (urban) in 4 qtr 2003
• Later scaled-up to 70 districts (15 states and 1
  UT)
• Currently being scaled-up to the entire country
• Modified surveillance system implemented in the
  14 districts to measure contributions from
  different types of providers

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GFATM Urban DOT Projects
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GFATM Urban DOTS Projects

• Based on PPM approach and targeting mainly the
  urban poor (urban slums)
• REACH project in Chennai funded under GFATM R-1
• Urban DOTS project in 4 cities funded under GFATM
  R-2
• Inter-Aide Mumbai
• Social Welfare Institute Varanasi
• Bhagwan Mahavir Medical Research Centre Hyderabad
• MP Voluntary Health Association (MPVHA) Indore
• IMA Project in five states and one UT under GFATM
  Round 6 launched in October 2007

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Results of Urban DOTS Projects

• Established baseline data on health providers and
  slum populations
• Improved patients adherence to treatment through
  DOT( Reduced default rate)
• Improved quality of private sector laboratory
  services by inclusion under RNTCP EQA system
• 6867 PPs/ 1769 PPM centres established
• On an average contributed 15-20 in case
  detection in the respective districts

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Workplace DOTS
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Benefits of Workplace DOTS

• Employer Benefits
• -Decreased absenteeism
• -Increased productivity
• - Increased morale at workplace
• Employee/Family Benefits
• - No loss of wages
• - No loss of workdays
• Community/Nation Benefits
• - Reduction in prevalence of TB
• - Reduction in morbidity and mortality of TB
• - Reduction in transmission of the infection
• Workplace DOTS is a WIN-WIN situation

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Involvement of workplace DOTS - examples

• Coal India - Burdwan (TU), Nagpur Ranchi (MC)
• Tea Industry - Jalpaiguri,Idukki,Nilgiris(MC)
• Steel/aluminium Plant - Hindalco, Rourkela,
  Bhillai, Keonjar(MC )
• Cement Factory - Sundergarh ,Katni, Raipur( MC )
• NTPC - Gautam Budh Nagar(MC)
• Jute mills - Howrah(TC)
• Mines - Keonjhar
• Sugar mills - Ghaziabad,Muzzarfarnagar,Daurala(TC)
  
• Petro-chemicals Industries Reliance in Surat
  (MC)

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Roles Industries play (contd.)
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RNTCP will

• Provide technical expertise and training
• Provide lab consumables, registers and patient
  cards for recording
• Provide free drugs in Patient wise boxes
• Monitor and report results on a monthly basis
• Share results on RNTCP web site
• Provide awareness material templates/ prototypes

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Challenges

• Huge private sector but proportionately less
  involvement of private providers
• Reluctance of Private and NGO sectors to sign
  formal agreements with government
• Getting private sector to agree to be supervised
  and quality assured by Government staff
• Mutual recognition, continuing dialogue and
  sharing of responsibilities is a key to success

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Future plans

• Dissemination of PPM training/sensitization tools
• Standardized approach tools to enhance access
  to DOT services in Urban slums
• Revision of the NGO/PP schemes
• Collaboration with CBCI
• - monitoring its health facilities for RNTCP
  implementation
• - documenting its contribution

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Thanks

• www.tbcindia.org

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Reliance TB Control Centre, SURAT, Gujarat
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BHEL ,Bhopal , MP
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TEA estates ,Dibrugarh, Assam
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Tea Garden, Jalpaiguri, West Bengal
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