Lok Sabha Question No. 4039 (UNSTARRED), answered on 2018-08-10
Subject: Elimination of Tuberculosis
Ministry: HEALTH AND FAMILY WELFARE
Asked by: KALIKESH NARAYAN SINGH DEO, ANIL SHIROLE, George Baker

## GOVERNMENT OF INDIA MINISTRY OF HEALTH AND FAMILY WELFARE DEPARTMENT OF HEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 4039 TO BE ANSWERED ON 10 TH AUGUST, 2018

## ELIMINATION OF TUBER CULOSIS

## 4039. SHRI KALIKESH N. SINGH DEO: SHRI ANIL SHIROLE: SHRI GEORGE BAKER:

Will the Minister of HEALTH AND FAMILY WELFARE be pleased to state:

- (a) the number of Tuberculosis Centres operational across the country, State/UT - wise including West Bengal;
- (b) the status of review Committees established b y the States following a letter from the Prime Minister in December 2017 to monitor tuberculosis elimination;
- (c)  the  details  of  plans  to  ensure delivery  of  cash  incentives  of  Rs.  500  per month  to  the remaining 92.5 per cent of notified tuberculosis patients who haven't yet received the same;
- (d) whether the Government plans to include districts such as Bolangir in Odisha in the public -private Joint Effort for the Elimination of Tuberculosis (JEET) programmes, if so, the details thereof along with th e reasons/criteria for not selecting districts;
- (e) the Government's plan to ensure drug availability, geographic accessibility, human resource availability, time - bound responses and supply -chain managementunder the JEET programme; and
- (f) the Governmen t's plans to ensure standardized care for the remaining no - JEET districts of the country?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILY WELFARE (SHRI ASHWINI KUMAR CHOUBEY)

- (a): The details of the number of Tuberculosis Centres operational across the country, State / UT - wise including West Bengal are enclosed at Annexure.
- (b): After  the  Prime  Minister's  letter  to  Chief  Minister  on  TB,  several  State/UTs  have intensified monitoring and review of the progress on tuberculosis elimi nati n. The review aims at  tracking  progress  on  key  priority  and  new  initiatives  undertaken  by  Revised  Nat Tuberculosis  Control  Programme  (RNTCP)  like  daily  regimen,  universal  drug  susceptibil testing, active TB case finding in vulnerable groups an d cross reference between HIV and TB control services.

State/UTs are conducting review of the programme under the Chairmanship of Healt Minister  or  Secretary  Health  at  the  State  level.  Similarly,  the  programme is  reviewed  by  the District  Collector  /  Magistrate  at  the  district  level.  The  State  level  reviews  are quarterly, and the District level reviews are conducted monthly.

The  Central  Government  is  also  regularly  monitoring  the  State  Government s  on implementation of the Revised National Tuberculosis Control Programme (RNTCP).

(c): Nikshay Poshan Yojana (NPY) for providing financial incentive of Rs 500/ - per month for nutritional support is being delivered since 1st April, 2018 through a DBT mec hanism by linking of NIKSHAY portal with Public Financial Management System (PFMS). The scheme has been onboard in DBT portal.

Guidelines have been developed and issued to all States/UTs. Through NIKSHAY a beneficiary wise list is generated and the sa me is duly submitted to PFMS after validation by the competent authorities at the district level. For demand generation, the districts are p the scheme using local measures. The private sector is being sensitized through distri branches of  professional  bodies  like  the  Indian  Medical  Association  (IMA)  and  Indi Association of Paediatrics (IAP)

- o Directives have been issued to all State/UTs to expedite implementation of the schem regular  review  and  monitoring  of  the  State/UTs  is  being  u ndertaken  by  the  Central Government.

(d): Reaching  to  TB  patients  in  private  sector  has  been  one  of  the  key  priorities National Strategic Plan (2017 - 25) for elimination of TB in India. To this effect, JEET proje aims  to  set - up  structures  to  strengthen  existing  systems  to  extend  quality  of TB  care  to  TB patients seeking care in private sector. To have maximum impact within the resources avai the project activities are planned for a limited duration (Jan 2018 to March 2021) and in 33 cities & 358 districts of the country where at the time of selection, higher number of private sector notifications were reported to the RNTCP through NIKSHAY.

In  the  remaining  districts,  wherein  there  is  a  significant  presence  of  private including  Bolangir  district,  the  above  project  pro vides  for  technical  support  through  Public Private Mix Coordinators specifically to support private sector engagement.

(e): Adequate  drugs  have  been  procured  by  the  programme  to  account  for  all  patien including  private  sector  patients  in  the  country.  F or  any  patient  in  public  or  private  sector including  those  under  JEET  project  once  diagnosed/notified  are  eligible  to  avail  prog drugs. The supply chain management for programme is being extended through a software i Nikshay Aushadhi to supply drug s to the private doctors/chemists for storage and distribution.

(f): Standardized  care  in  private  sector  is  one  key  element  of  private  sector  engag strategy. First step is to obtain notifications from private sector. Private doctors in a are continually  being  approached  for  notifying  TB  cases.  Once  adequate  data  on  private  do treating  TB  patients  is  obtained  then  these  are  the  ones  being  targeted  with  IEC, workshops and notifications to adhere to the Standards of TB Care in Ind ia (STCI). Following STCI  improves  diagnostic  and  treatment  practices  of  private  sector  including  trea adherence support, follow up, Contact Tracing, Chemoprophylaxis & social support systems their patients.

Complete follow up helps to track treatment outcomes of different patients treated by practitioners.

Also  a  Memorandum  of  Understanding  (MOU)  has  been  signed  with  Indian  Medical Association (IMA) for nationwide sensitization of the private practitioners on standard and RNTCP. The national level workshop for State level coordinators of IMA was recently h in Mumbai. About 1000 Continuing Medical Education programmes are planned, which would sensitize 50000 private providers and 10000 additional providers are estimated to be regis ered in Nikshay, following this activity.

Also, under programme strict enforcement of provisions of Schedule H1 in coordinat with  State/District  Drug  Controllers  is  being  initiated.  The  details  of  patient  an prescribing Anti TB drugs are being recorded and registered in Nikshay portal. This surveillanc data  is  used  as  intelligence  to  understand  treatment  practices  and  accordingly  identi needing further training/guidance. Public Health Actions as appropriate are being provide pat ients seeking care in private sector.

ANNEXURE

| S. No   | State               |   Number of PHIs* |   No. of PHIs which also have Designated Microscopy Centres (DMCs) * |
|---------|---------------------|-------------------|----------------------------------------------------------------------|
| 1.      | Andaman & Nicobar   |                34 |                                                                   17 |
| 2.      | Andhra Pradesh      |              1723 |                                                                  630 |
| 3.      | Arunachal Pradesh   |               179 |                                                                   32 |
| 4.      | Assam               |              1315 |                                                                  373 |
| 5.      | Bihar               |               868 |                                                                  726 |
| 6.      | Chandigarh          |                41 |                                                                   18 |
| 7.      | Chhattisgarh        |              1043 |                                                                  840 |
| 8.      | Dadra &Nagar Haveli |                13 |                                                                    9 |
| 9.      | Daman &Diu          |                 8 |                                                                    4 |
| 10.     | Delhi               |               284 |                                                                  192 |
| 11.     | Goa                 |                41 |                                                                   21 |
| 12.     | Gujarat             |              2384 |                                                                 1327 |
| 13.     | Haryana             |               673 |                                                                  277 |
| 14.     | Himachal Pradesh    |               710 |                                                                  202 |
| 15.     | Jammu &Kashmir      |               537 |                                                                  199 |
| 16.     | Jharkhand           |               421 |                                                                  328 |
| 17.     | Karnataka           |              3150 |                                                                  715 |
| 18.     | Kerala              |              1414 |                                                                  554 |
| 19.     | Lakshadweep         |                10 |                                                                    9 |
| 20.     | Madhya Pradesh      |              1639 |                                                                  891 |
| 21.     | Maharashtra         |              3209 |                                                                 1472 |
| 22.     | Manipur             |               118 |                                                                   55 |
| 23.     | Meghalaya           |               224 |                                                                   82 |
| 24.     | Mizoram             |               120 |                                                                   60 |
| 25.     | Nagaland            |               151 |                                                                   43 |
| 26.     | Odisha              |              1719 |                                                                  572 |
| 27.     | Puducherry          |                64 |                                                                   30 |
| 28.     | Punjab              |              2028 |                                                                  276 |
| 29.     | Rajasthan           |              3098 |                                                                 2202 |
| 30.     | Sikkim              |                43 |                                                                   37 |
| 31.     | Tamil Nadu          |              2515 |                                                                  823 |
| 32.     | Telangana           |               915 |                                                                  398 |
| 33.     | Tripura             |               125 |                                                                   54 |
| 34.     | Uttar Pradesh       |              3841 |                                                                 1963 |
| 35.     | Uttarakhand         |               471 |                                                                  153 |
| 36.     | West Bengal         |              1890 |                                                                  952 |
|         | TOTAL               |             37018 |                                                                16536 |