Tuberculosis Control Project

Overview | Current Situation | Project Goal | Beneficiaries | Amount | Project Components

OVERVIEW 

Tuberculosis is the largest single cause of adult illness and death from a communicable disease in India. Its greatest impact is on the poor. However, the country has made remarkable progress in fighting the disease, receiving support from a World Bank-financed Tuberculosis Control Project. A Joint Monitoring mission, conducted by WHO and the Government of India in September 2003, found that, under the national TB program, each day more than 10,000 symptomatic patients are examined, more than 40,000 sputum slides are checked, more than 2,500 patients are placed on treatment, and nearly 500 lives are saved.

CURRENT SITUATION OF TUBERCULOSIS

Over 2 million people die of tuberculosis worldwide each year, around 400,000 of them in India alone. TB represents 3.7 percent of India's disease burden, 11 times that of malaria, and is the leading cause of death in the 15 to 45 year age group. Nationwide, about 1.7 million new cases occur every year. Increasing prevalence of HIV infection, which makes people more susceptible to TB, and drug resistant types of TB mean the disease will pose an increasingly serious public health hazard with a high economic burden for India for several decades to come.

The 2001 Revised National Tuberculosis Control Program status report of the Government of India estimated that the direct and indirect costs of tuberculosis to the country amounted to $3 billion per year.

PROJECT GOAL

The project aims to reduce preventable TB-related sickness and death in India by preventing the increase of infectious tuberculosis, the chances of being infected by the Tubercle germ, and the development of drug resistance. The main feature of the project is the introduction of a revised strategy for tuberculosis control. It involves a major paradigm shift in terms of a focus on infectious cases.

BENEFICIARIES

The project is providing modern tuberculosis services, contributing to India's goal of reaching its population of over 1 billion people. Other donors involved in tuberculosis care services in India are Danida, DfID, USAID, GFATM, and the Stop TB Initiative. A second World Bank-supported TB project is under discussion with the Government of India.

 

AMOUNT

The $142.4 million project has supported the Revised National Tuberculosis Control Program (RNTCP) and has been effective since 1997. It is currently scheduled to close in 2004. This support has assisted in setting up the institutional and managerial infrastructure of the Revised National TB Control Program and expanding service provision to more than 725 million people across the country.

PROJECT COMPONENTS

• Improving the quality, access, and outcomes of TB treatment ($130.0 million)
• Developing institutional, operational, and research capacity and enhancing technical, managerial, and interpersonal skills ($16.2 million)
• Developing information, education, and communication and promoting outreach activities and community involvement ($5.9 million) 

The diagnosis of tuberculosis begins by testing people who have had symptoms—typically a chronic cough—for more than three weeks. Some people with TB germs are infectious, while others are not. Both, however, require treatment. Treatment varies from six to nine months. But it is effective only if continued regularly, failing which, chronic disease or drug resistance can result.

 

The program focuses on the individual by curing patients and on the community by interrupting the transmission of the disease. Interruption of transmission of the disease can be achieved within a reasonable period if the program covers over 70 percent of the population with cure rates of over 85 percent.

 

Activities that need to be carried out to achieve the desired outcomes are:

 

• Screening patients with chronic cough
• Sputum and, if necessary, X-ray examination to establish disease
• Initiation of appropriate, standardized treatment
• Ensuring regular treatment without any default
• Documentation of drugs intake and cure

The World Bank-supported nationwide TB Project introduced the new Directly Observed Treatment – Short Course, or DOTS, therapy in selected districts and city corporations, and promoted a major shift in the national strategy for TB control in India. The phased expansion of the project has enabled India to rapidly cover a population of approximately 728 million people in 414 districts in 28 states. The program is now the second largest DOTS program anywhere in the world. Over 2,750,000 cases have been treated as of November 2003.

 

Accordingly, the main elements of the strategy for the control of tuberculosis in India, which has been adopted by the Revised National TB Control Program, are establishment of microscopy/X-ray centers for the diagnosis of TB among outpatients; provision of individual, standardized drug boxes containing complete treatment for individual patients' supportive observation under directly observed treatment (DOTS) for avoidance of default by individual patients; and management supervision provided by the Senior Treatment Supervisors (STS) and Senior TB Laboratory Supervisors (STLS) supported by an effective MIS.

 

The new treatment, which is directed towards slowing down the transmission of TB by targeting infectious cases, has the advantage of being standardized and more effective. In the areas covered, the project has enabled a success rate of treatment of over 80 percent, while the death rate of patients has fallen dramatically to less than 4 percent. With older treatment regimens, completion rates have traditionally been about 30 percent, while death rates have been in the region of 20 to 30 percent.The assistance by the World Bank also supports special areas of focus which include:

 

Private–Public Partnerships. The project has involved over 550 nongovernmental organizations (NGOs), more than 2,000 private practitioners, and over 80 corporate houses. More than 31,000 community volunteers provide DOTS under the program.

 

Intersectoral Coordination. Anganwadi (voluntary) workers of the Ministry of Human Resource Development's Integrated Child Development Services program are involved as DOTS providers. Medical colleges are participating in the program by providing leadership in the areas of training. Other ministries involved are those of Mines and Coal, Shipping, and Labor.

 

HIV–TB Co-infection. Over 10,000 HIV-positive patients have been diagnosed with tuberculosis as a result of programs of coordination that are currently in place, contributing to about 2.8 percent of the total caseload in six states with high HIV prevalence. These systems are ongoing in six states while another eight states have initiated coordination programs.

Also see Tuberculosis Control Project documents

 

All dollar figures are in US dollar equivalents.
March 2004