National Tuberculosis Programme: a social perspective.

In the 1980s the existence of an estimated 8 million cases of tuberculosis (TB) indicated that the National Tuberculosis Program (NTP) had failed to reduce prevalence from the 1950s. Consequently a multidrug short-course chemotherapy was proposed to provide more aggressive treatment along with training of staff and intensive supervision. The strengths of the NTP are that it is a need-based program that it is integrated into the general health system that it uses cheap diagnosis and treatment technology that it has monitoring and evaluation systems and that it considers epidemiological trends. To have a major impact on the epidemiology of TB 70% of cases have to be eliminated continuously for 15-20 years; thus short-term reduction of prevalence will not suffice. The sociological components of NTP comprise simple and cheap preliminary diagnosis; symptoms compelled people to seek institutional help (although 50% were dismissed with cough mixture) and this proportion was used for passive case detection; and NTPs home treatment proved to be cheap and easily accessible allowing patients to continue their normal life. Domiciliary therapy was socially more acceptable promising higher patient compliance. Another social aspect of NTP was the high levels of default: incorrect diagnosis and failure to inform patients about the necessity of prolonged treatment. Social problems encountered in implementation had to do with treating TB as a component of an interdisciplinary approach combining it with family planning and malaria eradication programs which were given precedence in resource allocation. The technical programs of disease and population control overpowered the socially sensitive NTP and as a result TB control has failed. This meant that in urban clinics 80% of cases were lost because of organizational reasons. Another major social issue is that 50% of the people live below the poverty line and the problem of default can only be resolved if their living conditions are improved.