Health Policy Issues and Health Programmes in ... - Amazon S3

Tuberculosis Control Efforts in India and UttaranchalBeing a new state, Uttaranchal lacks infrastructure, such as STDCs at the state level and DTCs insome districts, as well as a manpower shortage pending transfer of staff between Uttaranchaland Uttar Pradesh. Difficult and hilly terrain is another constraint faced by the state.State-and district-level programme managers should realize that a poor TB control programmeis worse than no TB control programme at all. Without a TB control programme, infectiouscases eventually die out; however, with a poor TB control programme, infectious cases continuelonger without getting cured, thereby spreading infection to many more people. Theimmediate priority for the state is to start good quality DOTS implementation after a fullpreparation and appraisal of the districts. Initially, all efforts should focus on improving andmaintaining high-sputum conversion and cure rates. Experience from other parts of India hasshown that if service delivery starts poorly, bad habits develop, which subsequently becomedifficult to change; hence, the need to maintain quality right from the beginning.BibliographyBalasubramanian, VN, K Oommen, and R Samuel. 2000. “DOT or Not? Direct Observation ofAnti-tuberculosis Treatment and Patient Outcomes, Kerala State, India.” International Journalof Tuberculosis and Lung Disease 4: 409–413.Cao, JP, LY Zhang, JQ Zhu, and DP Chin. 1998. “Two-year Follow-up of Directly-observedIntermittent Regimens for Smear-positive Pulmonary Tuberculosis in China.” InternationalJournal of Tuberculosis and Lung Disease 2: 360–364.Centers for Disease Control and Prevention. 1993. “Initial Therapy for Tuberculosis in the Era ofMultidrug Resistance: Recommendations of the Advisory Council for the Elimination ofTuberculosis.” [published erratum appears in MMWR Morb Mortal Wkly Rep 1993 July 26;42(27): 536]. Morbidity and Mortality Weekly Report 42: 1–8.Central TB Division, Directorate-General of Health Services. 2000. Operational Guidelines forTuberculosis Control. New Delhi.Central TB Division, Directorate-General of Health Services. 2000. Technical Guidelines forTuberculosis Control. New Delhi.Cohn, DL, BJ Catlin, KL Peterson, FN Judson, and JA Sbarbaro. 1990. “A 62-dose, 6-monthTherapy for Pulmonary and Extrapulmonary Tuberculosis: A Twice-weekly, Directly Observed,and Cost-effective Regimen.” Annals of Internal Medicine 112: 407–415.Comolet, TM, R Rakotomalala, and H Rajaonarioa. 1998. “Factors Determining Compliancewith Tuberculosis Treatment in an Urban Environment, Tamatave, Madagascar.” InternationalJournal of Tuberculosis and Lung Disease 2: 891–897.192