National Tuberculosis Control Programme
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The National Tuberculosis Control Programme (NTCP) launched by Government of India (GOI) in 1962 was revised in 1992 to achieve a higher
cure rate of 85 per cent in a phased manner with the World Bank assistance.
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Item Performance Audit of National Tuberculosis Control Programme in West Bengal (1996-2001)(CAG of India, 2002) CAG of IndiaNational Tuberculosis Control Programme (NTCP) was implemented in the State since 1965 and Revised National Tuberculosis Control Programme (RNTCP) from 1999. Despite the implementation of the programme for 36 years sputum positive cases increased. Excess consumption/indiscriminate use of drugs created drug resistance. The programme implementation was marred by non-investigation of all suspects/symptomatics for TB, deficiency in sputum microscopy, shortage of microscopy centres, absence of proper health education, non-observance of dose medication, inadequate supervision and monitoring. Action plans were not prepared and supply of medicines was not regular; diagnostic facilities were inadequate. As a result target of new sputum smear positive patients remained largely unachieved. There were serious irregularities in purchase of medicines and issue of unnecessary medicines. Despite availability of funds, RNTCP was implemented late and all districts were not covered.Item Performance Audit of National Tuberculosis Control Programme in Assam (1996-2001)(CAG of India, 2002) CAG of IndiaTuberculosis (TB), a debilitating disease, continues to remain one of the leading infectious killer diseases and a most pressing health problem in the country. To prevent and control the disease the National Tuberculosis Control Programme (NTCP) was launched in Assam in 1962. Although Government of India introduced (1992) a revised strategy for National Tuberculosis Control Programme (RNTCP) to achieve a cure rate of over 85 per cent by implementing the Directly Observed Treatment (DOT) of Short Course Chemotherapy (SCC) in a phased manner throughout the country, the RNTCP was launched (November 1998) only in one district (Dibrugarh) of Assam. Review of the Programme revealed that there were dismal achievement in detection of new TB cases, low cure rate, inadequate or non-availability of infrastructure facilities, irregular supply of drugs, insignificant training activities and lack of proper monitoring. Annual Action Plans were not formulated nor any survey was undertaken to identify TB patients. Funds provided by the Government of India were either not released or there was delay in release/ utilisation of funds. Following are the main audit findings of this performance audit: 1. Out of Rs.2.54 crore provided by Government of India in cash during 1997-98 to 2000-2001 the department had not released Rs. 0.70 crore indicating that funds were diverted for other purposes instead of utilisation on the programme. 2. The department spent Rs.0.13 crore in excess of ceiling of funds for purchase of anti TB drugs during 2000-2001. 3. Targets and achievements for setting up TB units, TB dispensaries/chest clinics and microscopy centres during 1996-97 to 2000-2001 were not on record. 4. In 17 District Tuberculosis Centres 8 posts of Medical Officers and 52 posts of paramedical staff were lying vacant. Besides, there was no record of utilisation of 656 TB beds in government hospitals between 1996-97 and 2000-2001. 5. Contrary to Government of India orders (January 1999) the DHS had purchased Rifampicine Capsules and Pyrazinamide tablets valued at Rs. 0.54 crore during January 1999 to October 2000 out of the grants received from Government of India. In DTC Karbi-Anglong out of 3 lakh Rifampicine capsules received in October 1995 against indents placed by DGHS, shelf life of 1.07 lakh capsules valued at Rs. 6.42 lakh expired in October 1996 due to their supply in excess of requirement.Item Performance Audit of National Tuberculosis Control Programme in Goa(CAG of India, 2002) CAG of IndiaNational Tuberculosis Control Programme (NTCP) introduced in Goa since 1963 is implemented as a 100 percent centrally sponsored scheme. The State had not spent Rs.66.34 lakh received as grants during 1996-97 to 2000-01. The targets prescribed were unrealistic and not based on survey/prevalence of disease. On an average about 70 beds per month in TB Hospital, Margao were utilized against availability of 160 bed strength during 1996-2001. The percentage of TB defaulter patients was 55 during 1996-2001 and infructuous expenditure on partial treatment of defaulters was Rs.3.82 crore (approx.). Evaluation of the programme was not carried out to ensure effective implementation. Audit also found that Revised NTCP was not implemented in the State of Goa.Item Performance Audit of National Tuberculosis Control Programme in Kerala(CAG of India, 2002) CAG of IndiaThe Revised National Tuberculosis Control Programme (RNTCP), a 100 per cent Centrally Sponsored Scheme, was implemented in Kerala covering all the 14 districts in three phases. This performance review of the scheme covering the period 1996-97 to 2000-01 revealed low detection of TB cases due to low percentage of outpatients detailed for undergoing sputum tests, lack of infrastructure facilities for X-ray examination of sputum smear negative and extra pulmonary TB cases, shortage of microscopy centres and non-involvement of Medical College/ESI/Private hospitals and NGOs. Major audit findings are mentioned below: 1. Out of Rs. 5.90 crore received from GOI by State/District Tuberculosis Control Societies during 1996-2001, Rs 3.14 crore (53 per cent) remained unspent as of March 2001. 2. Shortage of Microscopy Centres and non-functioning of existing centres denied the benefit of laboratory testing facilities to TB patients in four districts. In seven out of 12 District TB Centres there were no facilities for X-ray examination for diagnosis of TB cases. 3. During 2000-01 shortfall in detection of TB cases ranged from 39 to 64 per cent in five test-checked districts. Similarly, detection of new sputum positive cases was only 48 to 70 per cent of the estimated national average during 1999-2001. The shortfall was mainly due to non-participation of Medical college/ ESI/ private hospitals and NGOs. 4. Children suffering from TB had no access to Directly Observed Treatment (DOT) under RNTCP. Failure of the DOT providers in furnishing the progress of treatment to the treatment centres would lead to non-follow-up of TB cases and could result in patients becoming Multi Drug Resistant. 5. There was no facility in the State for diagnosis of Multi Drug Resistant (MDR) TB and RNTCP had no provision for management of such patients.