The 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.