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Rajesh Das
BLOCKPUBLICHEALTHMANAGER
CHANDIPUR BPHU,ERASHAL RURAL HOSPITAL
CHANDIPUR,PURBA MEDINIPUR,WEST BENGAL
National Tuberculosis Elimination Programme
NTEP
"টিবি মুক্ত িাাংলা তথা টিবি মুক্ত নন্দীগ্রাম স্বাস্থ্য জেলা-২০২৫“
টিবি মুক্ত চণ্ডীপুর BPHU-২০২৫
What is Tuberculosis?
Tuberculosis (TB) is an infectious disease caused by
the bacterium Mycobacterium tuberculosis (MTB)
which generally affects the lungs, but can also affect
other parts of the body
One patient with infectious
pulmonary TB if untreated can
infect 10-15 persons in a year.
o Malnutrition
o Diabetes
o HIV infection
o Poor immunity
o Severe kidney disease
o Other lung diseases
like silicosis.
o Substance abuse etc.
o Overcrowding
o Inadequate
ventilation
o Enclosed living/
working conditions
o Occupational risks
Risk factors:
Showing that
3
TB Notification under NTEP
Vision: A world free of TB
Zero TB deaths, Zero TB disease, and Zero TB suffering
Goal: End the Global TB Epidemic (<10 cases per 100,000 population)
Sustainable Development Goals (SDG)
INDICATORS
TARGETS
SDG 2030
Reduction in number of TB deaths
compared with 2015 (%)
90%
Reduction in TB incidence (new case) rate
compared with 2015 (%)
80%
TB-affected families facing catastrophic
expenditures due to TB (%)
Zero
TB Free India
• India has committed to End
TB by 2025, 5 years ahead of
the global SDG target
• Prime Minister of India
launched TB Free India
campaign at ‘Delhi End TB
Summit’ on 13th March,
2018
• The campaign calls for a
social movement focused on
patient-centric and holistic
care driven by integrated
actions for TB Free India
More & more States committing to Ending TB
Chhattisgarh
Tamil Nadu
State level commitment 14
State/UT
Himachal Pradesh Kerala
Lakshadweep
Jharkhand
2020- Kerala
2021- Himachal Pradesh
2022- Gujarat,
Lakshadweep & Sikkim
2025- Bihar,Chhatisgarh,
Daman & Diu and Dadra &
Nagar Haveli, Jammu &
Kashmir,Jharkhand,
Madhya Pradesh,
Puducherry,Tamil Nadu
and Andaman & Nicobar
Islands
7
Strategies
Private
sector
engagement
Active
Case
Finding
TB
Co-
morbidities
Multi-
sectoral
response
Drug
Resistant
TB
ICT Tools for
adherence
and
monitoring
Preventive
Measures
Community
Engagement
National Strategic Plan (2017-25)
Organizational structure
Supporting Facilities
 National Reference
Laboratories (6)
 Intermediate Reference
Laboratories (31)
 Culture and DST Laboratories
(81 including IRL/NRL)
 CBNAAT Laboratories (1268)
 DRTB Centres- 703
Key Services
1. Free diagnosis and treatment for TB patient
2. Public health action- contact tracing, testing
for co-morbidities etc.
3. Treatment adherence support
4. Nutrition assistance to TB patients (DBT-
Nikshay Poshan Yojana)
5. Preventive measures
Strengthening Case Finding in the Public Sector
Chest X Ray:
Clinically diagnosed TB
increased from 8.8 lakhs in
2017 to 12.7 lakhs in 2019
Revised Diagnostic
Algorithm for TB: Increase
in DR-TB cases from 38,000
in 2017 to 66,000 in 2019
Upfront Rapid Molecular
Testing: Increased from
5.23 lakhs upfront tests in
2017 (16% yield) to 11.34
lakhs in 2019 (17% yield)
Intensive Case Finding in Health
facilities- Screening for TB
among:
-DM patients increased from
11.5 L in 2018 to ~20 L in 2019
- ICTC/ART referrals increased
from 3.35 L in 2017 to 3.94 L in
2019
Active Case Finding in vulnerable
population: from 5.5 crore
population screened in 2017 to
28 crores screened in 2019. Yield
increasing from ~27,000 to
~63,000 TB patients.
Leveraging Outreach of other
Healthcare Programmes: 8.3
lakhs referrals from Health &
Wellness Centres .
PASSIVE APPROACH TO CASE FINDING
ACTIVE APPROACH TO CASE FINDING
Treat
Treatment
Patient Centric Care
Reduce Out-of-pocket
Expenditure
• Daily Regimen
• Shorter Regimen
• Newer Drugs
• IT Enabled Adherence
Support
• Comorbidity
management
• Financial incentives
• Direct Benefit Transfer
Direct Benefit Transfer (DBT) schemes
1. Honorarium to Treatment Supporters – For provision of
treatment support to TB patients (Adherence, ADR
monitoring, counselling @Rs.1000/- to Rs.5000/-)
2. Patient Support to Tribal TB Patients (Financial Patient
Support @Rs750/-)
3. Nutritional Support to All TB patients (Financial Support to
Patients @Rs.500/-month)
4. Incentives to Private Providers (Rs.500/- for Notification &
Rs.500/- for reporting of Treatment Outcome
5. Incentives to Informant (Rs. 500/- is given on diagnosis of TB
among referrals from community to public sector health
facility)
Prevent
• Air borne infection
control measures
• Strengthen Contact
Investigation
• Preventive
treatment in high
risk groups
• Manage Latent TB
Infection
• Address
determinants of
disease
Multi-sectoral Engagement
TB care services in
health
infrastructure
Socio-economic
support &
Empowerment
Infection
Prevention
Address
Determinants
Information
Education
Communication
Prevention and
Care at Work Place
Corporate
Social
Responsibility
TB - A social problem & needs multi-sectoral approach
Inter-Ministerial Coordination
AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and
Homoeopathy)
•1st meeting of National Technical Expert Group on NTEP-AYUSH Collaboration &
e-consultation of experts held
•2nd draft of Policy Document and Joint Letter drafted
Railways
•Joint Working Group to be formed to monitor implementation
Defence
•Action Plan developed.
•95 Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinics registered in
Nikshay, remaining underway
Labour and Employment
• MoU signed in September 2020
Community Engagement
Transformation of TB survivors to TB
champions
Capacity building and mentoring
programme
Engagement of existing community
groups like PRI, SHG, VHSNC, MAS,
Youth Club
Grievance redressal mechanism
Involvement of community
representatives in different forums
TB Forums at the National, State
and District level to provide a
platform for all stakeholders,
including the community, to voice
their views
Call Centre- Nikshay Sampark
 1800-11-6666
 Outbound & Inbound
 Time – 7 to 11
 Languages – 14
 100 call centre agents
 Pan-India coverage
 Citizen – Patient - Providers
• Counselling
• Treatment
Adherence
•Grieva
nce
Redres
sal
• Follow Up
• TB
Notification
• Information
Policy Update in RNTCP, 2018
State TB Index
Policy Update in RNTCP, 2018
1. Under reporting and uncertain care of TB patients in
private sector
2. Reaching the unreached – Slums, Tribal, vulnerable
3. Drug Resistant TB
4. Co-morbidities – HIV, Diabetes
5. Undernutrition, overcrowding
6. Lack of awareness and poor health seeking behaviour lead
to delay in diagnosis
Key Challenges
Key Take Away
• Improve TB notification rate Ensure mandatory TB
notification from private sector
• Active TB Case Finding to reach the unreached
• Optimum utilization of CBNAAT machines
• Expand Universal Drug Susceptibility Testing coverage
• NIKSHAY Poshan Yojana to every TB patients
• 100% reporting through NIKSHAY
• Collaboration with Line Ministries to tackle social
determinants of TB
• Community participation for TB Elimination
Thank You
Bending the Curve
Accelerating towards a
TB free India

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Tuberculosis Elimination Efforts in Chandipur BPHU, West Bengal

  • 1. Rajesh Das BLOCKPUBLICHEALTHMANAGER CHANDIPUR BPHU,ERASHAL RURAL HOSPITAL CHANDIPUR,PURBA MEDINIPUR,WEST BENGAL National Tuberculosis Elimination Programme NTEP "টিবি মুক্ত িাাংলা তথা টিবি মুক্ত নন্দীগ্রাম স্বাস্থ্য জেলা-২০২৫“ টিবি মুক্ত চণ্ডীপুর BPHU-২০২৫
  • 2. What is Tuberculosis? Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis (MTB) which generally affects the lungs, but can also affect other parts of the body One patient with infectious pulmonary TB if untreated can infect 10-15 persons in a year. o Malnutrition o Diabetes o HIV infection o Poor immunity o Severe kidney disease o Other lung diseases like silicosis. o Substance abuse etc. o Overcrowding o Inadequate ventilation o Enclosed living/ working conditions o Occupational risks Risk factors:
  • 4. Vision: A world free of TB Zero TB deaths, Zero TB disease, and Zero TB suffering Goal: End the Global TB Epidemic (<10 cases per 100,000 population) Sustainable Development Goals (SDG) INDICATORS TARGETS SDG 2030 Reduction in number of TB deaths compared with 2015 (%) 90% Reduction in TB incidence (new case) rate compared with 2015 (%) 80% TB-affected families facing catastrophic expenditures due to TB (%) Zero
  • 5. TB Free India • India has committed to End TB by 2025, 5 years ahead of the global SDG target • Prime Minister of India launched TB Free India campaign at ‘Delhi End TB Summit’ on 13th March, 2018 • The campaign calls for a social movement focused on patient-centric and holistic care driven by integrated actions for TB Free India
  • 6. More & more States committing to Ending TB Chhattisgarh Tamil Nadu State level commitment 14 State/UT Himachal Pradesh Kerala Lakshadweep Jharkhand 2020- Kerala 2021- Himachal Pradesh 2022- Gujarat, Lakshadweep & Sikkim 2025- Bihar,Chhatisgarh, Daman & Diu and Dadra & Nagar Haveli, Jammu & Kashmir,Jharkhand, Madhya Pradesh, Puducherry,Tamil Nadu and Andaman & Nicobar Islands
  • 8. Organizational structure Supporting Facilities  National Reference Laboratories (6)  Intermediate Reference Laboratories (31)  Culture and DST Laboratories (81 including IRL/NRL)  CBNAAT Laboratories (1268)  DRTB Centres- 703
  • 9. Key Services 1. Free diagnosis and treatment for TB patient 2. Public health action- contact tracing, testing for co-morbidities etc. 3. Treatment adherence support 4. Nutrition assistance to TB patients (DBT- Nikshay Poshan Yojana) 5. Preventive measures
  • 10. Strengthening Case Finding in the Public Sector Chest X Ray: Clinically diagnosed TB increased from 8.8 lakhs in 2017 to 12.7 lakhs in 2019 Revised Diagnostic Algorithm for TB: Increase in DR-TB cases from 38,000 in 2017 to 66,000 in 2019 Upfront Rapid Molecular Testing: Increased from 5.23 lakhs upfront tests in 2017 (16% yield) to 11.34 lakhs in 2019 (17% yield) Intensive Case Finding in Health facilities- Screening for TB among: -DM patients increased from 11.5 L in 2018 to ~20 L in 2019 - ICTC/ART referrals increased from 3.35 L in 2017 to 3.94 L in 2019 Active Case Finding in vulnerable population: from 5.5 crore population screened in 2017 to 28 crores screened in 2019. Yield increasing from ~27,000 to ~63,000 TB patients. Leveraging Outreach of other Healthcare Programmes: 8.3 lakhs referrals from Health & Wellness Centres . PASSIVE APPROACH TO CASE FINDING ACTIVE APPROACH TO CASE FINDING
  • 11. Treat Treatment Patient Centric Care Reduce Out-of-pocket Expenditure • Daily Regimen • Shorter Regimen • Newer Drugs • IT Enabled Adherence Support • Comorbidity management • Financial incentives • Direct Benefit Transfer
  • 12. Direct Benefit Transfer (DBT) schemes 1. Honorarium to Treatment Supporters – For provision of treatment support to TB patients (Adherence, ADR monitoring, counselling @Rs.1000/- to Rs.5000/-) 2. Patient Support to Tribal TB Patients (Financial Patient Support @Rs750/-) 3. Nutritional Support to All TB patients (Financial Support to Patients @Rs.500/-month) 4. Incentives to Private Providers (Rs.500/- for Notification & Rs.500/- for reporting of Treatment Outcome 5. Incentives to Informant (Rs. 500/- is given on diagnosis of TB among referrals from community to public sector health facility)
  • 13. Prevent • Air borne infection control measures • Strengthen Contact Investigation • Preventive treatment in high risk groups • Manage Latent TB Infection • Address determinants of disease
  • 14. Multi-sectoral Engagement TB care services in health infrastructure Socio-economic support & Empowerment Infection Prevention Address Determinants Information Education Communication Prevention and Care at Work Place Corporate Social Responsibility TB - A social problem & needs multi-sectoral approach
  • 15. Inter-Ministerial Coordination AYUSH (Ayurveda, Yoga & Naturopathy, Unani, Siddha and Homoeopathy) •1st meeting of National Technical Expert Group on NTEP-AYUSH Collaboration & e-consultation of experts held •2nd draft of Policy Document and Joint Letter drafted Railways •Joint Working Group to be formed to monitor implementation Defence •Action Plan developed. •95 Ex- Servicemen Contributory Health Scheme (ECHS) Polyclinics registered in Nikshay, remaining underway Labour and Employment • MoU signed in September 2020
  • 16. Community Engagement Transformation of TB survivors to TB champions Capacity building and mentoring programme Engagement of existing community groups like PRI, SHG, VHSNC, MAS, Youth Club Grievance redressal mechanism Involvement of community representatives in different forums TB Forums at the National, State and District level to provide a platform for all stakeholders, including the community, to voice their views
  • 17. Call Centre- Nikshay Sampark  1800-11-6666  Outbound & Inbound  Time – 7 to 11  Languages – 14  100 call centre agents  Pan-India coverage  Citizen – Patient - Providers • Counselling • Treatment Adherence •Grieva nce Redres sal • Follow Up • TB Notification • Information Policy Update in RNTCP, 2018
  • 18. State TB Index Policy Update in RNTCP, 2018
  • 19. 1. Under reporting and uncertain care of TB patients in private sector 2. Reaching the unreached – Slums, Tribal, vulnerable 3. Drug Resistant TB 4. Co-morbidities – HIV, Diabetes 5. Undernutrition, overcrowding 6. Lack of awareness and poor health seeking behaviour lead to delay in diagnosis Key Challenges
  • 20. Key Take Away • Improve TB notification rate Ensure mandatory TB notification from private sector • Active TB Case Finding to reach the unreached • Optimum utilization of CBNAAT machines • Expand Universal Drug Susceptibility Testing coverage • NIKSHAY Poshan Yojana to every TB patients • 100% reporting through NIKSHAY • Collaboration with Line Ministries to tackle social determinants of TB • Community participation for TB Elimination
  • 21. Thank You Bending the Curve Accelerating towards a TB free India

Hinweis der Redaktion

  1. 1.89 lakhs in 2019- tb through naat upfront 2018-3.35 lakhs referrals from ART
  2. In RNTCP, one of the first health programs to move to DBT, will be using it to transfer monetary benefits to eligible patients and providers. We would be using Nikshay to identify the beneficiaries and the transfer of funds will be through the Public Financial Management System or PFMS