Revised National TB Control Programme (RNTCP)

The Revised National TB Control Programme (RNTCP), based on the internationally

recommended Directly Observed Treatment Short-course (DOTS) strategy, was launched in 1997
expanded across the country in a phased manner with support from World Bank and other development
partners. Full nation wide coverage was achieved in March 2006 covering over a billion population (1114
million) in 632 districts / reporting units. In terms of treatment of patients, RNTCP is the largest and the
fastest expanding programme in the world.

The Goal of the programme: The goal of TB control Programme is to decrease mortality and morbidity
due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

The objectives of the programme are to

a. To achieve and maintain cure rate of at least 85% among New Sputum Positive patients.

b. To achieve and maintain case detection of at least 70% of the estimated NSP cases in the
community

RNTCP Achievements:

• India is highest TB burden country in the world, accounting for nearly one-fifth of the global
incidence. In 2007, out of the global annual incidence of 9.23 million TB cases, 1.96 million were
estimated to have occurred in India, of whom 0.8 million were infectious cases.

• In 1999, the Indian expansion of RNTCP accounted for 1/3 and in 2000 and 2001 for over 1/2 of the
global increase in DOTS coverage. In 2005 alone, 1.29 million TB patients were initiated on
treatment. In 2006, 1.39 million and in 2007, 1.48 million patients have been enrolled for treatment. In
2008 over 1.51 million patients have been initiated on treatment.

• India has contributed to approximately 24% of the total global new cases detection during the year
2007 as per the WHO Global Report 2009.

• Treatment success rates have tripled from 25% to 86%. TB death rates have been cut 7-fold from 29%
to 4%.

• Since its inception, the Programme has initiated over 10 million patients on treatment, thus saving
more than 1.8 million additional lives
• The programme has consistently maintained the treatment success rate >85% and NSP case detection
rate close to the global target of 70%. In 2008, RNTCP has once again achieved the new sputum
positive case detection rate of more than 70% (72%) and treatment success rate of 87% which is in
line with the global targets for TB control.

• The programme achieved 70% NSP case detection rate and 87% treatment success rate during 1st
quarter 2009.

• Monitoring, supervision and evaluation: All states are currently implementing the ‘Supervision and
Monitoring strategy’ – detailing guidelines, tools and indicators for monitoring the performance from
the PHI level to the national level. The programme is focusing on the reduction in the default rates
amongst all new and re-treatment cases and is undertaking steps for the same.

• Quality assured diagnostic facilities are available through more than 12,500 laboratories across the
country. As a result, the proportions of sputum positive cases confirmed in the laboratory are double
to that of the previous programme and are on par with international standards.

• External Quality Assurance: To ensure quality, external quality assurance of sputum microscopy is
being routinely conducted throughout the country. The protocol being implemented has taken into
consideration the recommendations of the recently published international guidelines and has all
components for ensuring quality – on site evaluation, panel testing and blinded crosschecking.

o To improve access to tribal and other marginalized groups the programme has developed a
Tribal action plan which is being implemented with the provision of additional TB Units and
DMCs in tribal/difficult areas, additional staff, compensation for transportation of patient &
attendant in tribal areas, Higher rate of salary to contractual staff etc.

• Impact of the programme:

o Prevalence of all forms of TB has been brought down from 586/lakh population (1990) to
283/lakh population in 2007 and TB mortality in the country has reduced from over 42/lakh
population in 1990 to 28/lakh population in 2007 as per the WHO global report 2009.

o National estimates of ARTI prior to 2000 were 1.7 and estimates based on National ARTI
survey in 2001-03 is 1.5.

o Repeat population surveys conducted by TRC indicate an annual decline in prevalence of

disease by 12%.
• Paediatric patient wise boxes have been introduced under the programme for treatment of paediatric
patients suffering from TB since 2006. These boxes are designed according to the dosages used for
different weight bands. All the key RNTCP staff has been trained in the use of these boxes

• Over 2500 NGOs, 19500 private practitioners, and 150 corporate in the provision of RNTCP services.
Presently, 267 medical colleges (including private colleges) have been involved in RNTCP by the end
of 4Q08. Health facilities in government sectors outside Health Ministry have been involved viz. ESI,
Railways, Ports and the ministries of Mines, Steel, coal, etc. Intensified IMA-PPM project is being
undertaken in 167 districts of 6 states. CBCI, a faith based organisation (FBO), is undertaking RNTCP
activities in 11 states.

• TB HIV coordination

o The collaborative activities presently being undertaken in 14 states and scaled up to involve all
the states in 2007

o NACP & RNTCP have developed “National framework of joint TB/HIV Collaborative
activities” in 2007 which was revised in Feb. 2008 to redefines the scopes of TB/HIV
collaborative activities being implemented in the country

o In 2008, more than 1,80,000 TB suspects were referred from ICTCs to RNTCP and of them
more than 20,000 were diagnosed as having TB and initiated on DOTS. More than 125,000
TB patients were tested for HIV and of them about 11,800 were diagnosed as HIV positive and
offered access to HIV care.

• Drug Resistance Surveillance:

To know the prevalence of drug resistance amongst new cases and re-treatment cases, state wide
community based surveys have been carried out in the states of Gujarat and Maharashtra. These
surveys estimate the prevalence of Multidrug resistant TB (MDR-TB) to be ~3% in new cases and 12-
17% in retreatment cases. These surveys also indicate that the prevalence of MDR-TB is not
increasing in the country. Two more surveys are underway in the states of AP and UP and there is a
plan to undertake a survey in Orissa in near future.

• DOTS Plus for management of MDR-TB

o The programme is in the process of establishing a network of about 27 accredited Culture and
Drug Susceptibility testing Intermediate Reference Laboratories (IRL) across the country in a
phased manner for diagnosis and follows up of MDR TB patients. The IRLs at Gujarat,
 Maharashtra, Andhra Pradesh, Delhi, Kerala, Tamil Nadu, Rajasthan have been accredited
recently. Another 6 IRLs (Haryana, West Bengal, Uttarakhand, Chattisgarh, Jharkhand and
Orissa) are under the accreditation process and are expected to be accredited in 2009. The
remaining IRLs will be accredited in 2010.

o To supplement and support the IRL network the programme is also involving
Mycobacteriology laboratories of Government Medical Colleges as well laboratories in the
NGO and Private Sector. Till date, two NGO labs (CMC-vellore and BPRC-Hyderabad) have
been accredited and about 12 such labs have applied for accreditation.

o DOTS Plus services for management of MDR TB have been rolled out in the states of Gujarat,
Maharashtra, Andhra Pradesh, Haryana, Delhi, Kerala, West Bengal, Tamil Nadu and
Rajasthan. Till date a total of around 400 MDR-TB patients are on treatment in these states.

o The state of Rajasthan is in advanced stage of preparation and is expected to initiate DOTS
Plus services in 2009. Remaining states will be covered under DOTS Plus in 2009-10.

• ACSM/IEC

o The media agency has been hired to support the IEC activities at the national level

o Most of the states have appointed communication facilitators to support the IEC activities at
the district level

o Quarterly reporting on IEC activities is in place and is monitored at the state and central level

• Assessment of impact

Studies conducted by the National TB Institutes, TB Research Centre, Chennai and NTI, Bangalore
suggest an annual decline in prevalence by around 9-11%. India should be able to achieve the MDG
if an average of 5% annual decline is maintained.T he programme has initiated surveys to assess the
impact of RNTCP and progress towards TB related Millennium Developmental goals.

o Disease prevalence surveys are ongoing at 7 sentinel sites.

o The National ARTI survey is being undertaken by NTI, Bangalore in collaboration with LRSI,
New Delhi; CMC, Vellore; New Delhi TB Centre and MGIMS, Wardha.

• Financial Status

o Allocation under the XIth plan (2007-12)

Total budget of Rs. 1447.00 Crores has been approved by the planning commission for the
implementation of RNTCP under the XIth plan.
 Year Budget Outlay Expenditure
(in crores) (in crores)
2007-08 267.00 262.12
2008-09 275.00 * 279.9
2009-10 297.25 72.5 (as on 15th June ’09)
* Provision increased to Rs. 280.00 crores at RE Stage.

• The three yearly Joint Monitoring Mission of RNTCP was conducted along with the World Bank
midterm review of the RNTCP Phase-2 project, from 15-28th April, 2009. The team was represented
by all the donor agencies and important national and international partners. The mission teams visited
6 states covering 16 districts from 16th to 22nd April, 2009. The team also held detailed discussions at
Delhi from 23rd to 27th and made the presentation on the findings and recommendations to The
Secretary (Health and Family Welfare, MoHFW, GoI) on 28th April, 2009. The programme
achievements in term of its scale up capacity, periodic revision of strategy, monitoring and evaluation,
MDR-TB implementation and TB HIV interventions have been greatly appreciated during the
mission. The challenges of sustained financing, inadequacy of staff, sustaining a functional laboratory
network and necessity of regulation on prescription and sale of anti TB drugs were highlighted.