Any future expansion will have to be phased to ensure that drug supplies, training, supervision, and monitoring can all be guaranteed. The stakes are high. An estimated one in two of the adult population are infected with the TB bacterium. Launched in 1993 with a series of successful small-scale pilot projects, the DOTS programme has shown continued impressive success rates. Treatment is supervised by health workers, community volunteers, traditional birth attendants, and community or religious leaders.
Community workers supervise treatment for patients with limited access to a health centre.
Additional staff are provided to serve difficult mountainous, tribal, and urban areas. In order to maintain the uninterrupted supply of drugs throughout the treatment period, each patient is allocated an individual box at the outset containing the full course of treatment. This helps ensure that no patient has to stop treatment because drugs are not available, even in the event of a break in the drugs supply chain. Ironically, India was one of the seedbeds for the global DOTS strategy, but it was many years before the idea took root there. In the early 1960s, India demonstrated that most TB patients did not need to be in hospital.