Health and Development Initiative-India, (www.healthinitiative.org), publishes ‘TB News from India' once every two months. The objective of newsletter is to highlight issues related to Tuberculosis and HIV/AIDS control in India and enlist political, public, professional and administrative support for its cause. Health and Development Initiative-India is a not-for-profit organization and the news items have been quoted from various sources for fair use and in public interest. Reproduction of the material published is welcome provided a reference is made to the original source of the news item and TB News from India.

Editorial note:  

WHO and ILO launch "Guidelines for Workplace TB Control Activities"

On the occasion of the World Economic Forum Africa Summit, a new effort to protect the health of millions of workers was launched by the World Health Organization (WHO) and the International Labour Organization (ILO), with the release of guidelines for TB control activities in the workplace.

In a foreword to the guidelines, WHO Director-General, Dr Gro Harlem Brundtland, and ILO Director-General Mr. Juan Somavia write: “TB is a workplace issue because health is essential not only to the well-being of individuals but the functioning of economies. Poor health among working people is a threat to the viability of enterprises and the national stock of human capital. The productivity of the workplace, in particular, is weakened by the loss of skills and experience, absenteeism, disrupted production, and escalating direct costs”. 

There are two facets to workplace TB control activities. Firstly, the workplace represents an opportunity for making TB control convenient and accessible to infected workers. Secondly, workers have the right to operate in an environment that does not pose undue hazards to health, and employers have the responsibility to implement measures that decrease the occupational risk of TB. These measures comprise environmental controls and the steps to identify and ensure the treatment of employees with TB and therefore to stop the cycle of TB transmission, they add.

In India an Employees State Insurance Scheme is in place to look after the health of industrial workers and their families. Employees State Insurance Corporation (ESIC) looks after the health of 33 million family members of 8.5 million industrial workers who pay to the corporation every month for the provision of health facilities and sickness benefits. ESIC runs 140 hospitals, 1453 dispensaries and has a network of over 6000 private medical practitioners all over the country. Unfortunately it has not been fully integrated with DOTS. RNTCP Status Report 2003 published by Central TB Division mentions only Ahmedabad in Gujrat where initial contacts have been developed between RNTCP and ESIC. The workplace programmes to put in place TB control activities remain a fall cry. 

Besides these industrial workers whose organizations subscribe to ESIC there are a large number of other workers who do not have access even to ESIC and its health facilities. In a country where minimum industrial wages are around $ 1 per day these workers live in large urban slums and constitute a vulnerable group who have a little access to DOTS. 

The initiative by WHO and ILO comes at a very appropriate time for India. DOTS services are expanding at a very fast pace here, but accessibility issues continue to daunt its success. One can hope that managers of RNTCP in India will take notice of these guidelines and take steps for quicker integration of ESIC with DOTS to make a small beginning in this direction.

A booklet "Guidelines for Workplace TB Control Activities" published by WHO and ILO is available for download at: http://www.stoptb.org/wp_guidelines.pdf  

Staying alert to the TB menace in Navi (New) Mumbai

The township of Navi Mumbai, on the outskirts of Mumbai city, has a population of around 6,20,000 people, an estimated 120,000 of whom are migrant workers. These workers are in the high-risk group for contracting tuberculosis, thanks to the backbreaking nature of their jobs, few benefits, appalling living conditions, poor nutrition and inadequate access to healthcare facilities. 

Till the early 1990s the region enjoyed a construction boom, employing thousands of contract workers, mostly migrants. Large and small-scale factories mushroomed here. But a national recession in industrial production hit this area too. 

There were 2,200 units on the manufacturers association records, today they are barely 550, 70 % in ‘terrible shape’. Former industrial workers are forced to earn a living selling vegetables or as rickshaw drivers.

In 1989 Alert India, a local NGO recognizing the woeful lack of municipal health services in Navi Mumbai decided to extend the scope of its work to that area and to include TB patients. The Navi Mumbai Municipal Corporation (NMMC) was set up in 1995. Within two years it had established urban health posts (UHPs) and MCH centres.

Between November 1998 and 2000, the NMMC/Alert non-Directly Observable Treatment TB programme had 2,622 registered patients. The last patient completed treatment/defaulted/died/ or was transferred in October 2001. According to a report on the programme, overall, 64% of patients completed treatment and were cured. A little less than 50% of sputum-positive patients (572 out of 1,028) became sputum-negative and were declared cured.

In November 2000, the NMMC qualified for the Directly Observable Treatment (DOTS) -- Short Course and took over the TB programme from Alert India. However, when the NMMC reviewed its first quarter in April 2001, it decided to re-involve Alert India. From May 2001, Alert worked with the NMMC to follow up on all DOTS patients in five urban health posts in two zones: Turbhe Sanpada and Airoli-Dighe. 

Alert’s work begins at 7.30 in the morning, when the 12 staff workers begin visiting the area. They check new addresses of TB patients, follow up and visit the urban health posts. DOTS has undoubtedly helped patients who are unable to visit clinics. They get themselves registered with a ‘DOTS provider’ close to their home -- an urban health post, doctor, or even the local paanwalla (betel leaf vendor). For the first ‘intensive’ phase of treatment, they consume the medicine in the presence of the DOTS provider who maintains an attendance register for Alert and the NMMC.

“The Alert-NMMC collaboration is fruitful,” says Joy Mancheril Assistant Director of project “Patients can talk to us about their fears and anxieties in a way that they cannot with the government services. The NMMC staff also feels supported, our records help their work.” 

You can read the full story at:
http://www.infochangeindia.org/HealthIstory.jsp?section_idv=2&storyofchangev=HealthIstory.jsp  

Stop TB Partner's Forum to meet at New Delhi in December 2003

The Stop TB Partnership Secretariat announced that the Second Stop TB Partners' Forum would take place on 4-5 December 2003 in New Delhi, India. The Forum will focus on Partnership progress in implementing the Global Plan to Stop TB, highlighting the importance of progress at the country level and private and civil sectors involvement.

The Stop TB Partners' Forum has four overall objectives: 

· Report on progress of the Partnership since the 1st Stop TB Partners’ Forum in Washington, USA; 
· Further accelerate efforts to address country constraints, needs and proposed solutions to reach TB targets; 

· Strengthen non-governmental (private and civil sectors) support to the implementation of Stop TB activities; 

· Highlight the human face of TB through involvement of people who have been afflicted by TB (and HIV/AIDS) 

India has the largest number of TB cases in the world, and it is also one of the countries making the most rapid progress in expanding DOTS. With the present rate of progress and if they continue to address the major challenges, India is going to reach the global TB targets by 2005. India is an example for many other countries struggling with TB, and we are pleased that the Government of India has agreed to host the Forum said the Stop TB Secretariat in an announcement.

Shifting the focus of Tuberculosis Research in India

A study by P. R. Narayanan of Tuberculosis Research Centre and three others published in Tuberculosis (Volume 83, Issues 1-3, 2003, Pages 135-142) says that the focus of TB research in India has shifted to the following operational research areas: evaluating models to involve the private health sector; assessing the role of incentives in increasing treatment compliance; examining gender differentials in the access to TB services; assessing risk factors for delay in diagnosis; evaluating diagnosis, treatment and prevention of TB among HIV-infected persons; monitoring MDR-TB; estimating cost-effectiveness of the DOTS programme; monitoring the quality of smear microscopy services; and measuring the current burden of TB.

It calls for greater networking among national researchers, programme managers and policy-makers to translate the findings of research into policies and programmes to make TB control in India more effective and efficient.

(doi: 10.1016/S1472-9792(02)00068-9 . Copyright © 2003 Elsevier Science Ltd. All rights reserved) 

12 patients driven out of AIDS Centre

Lack of awareness on AIDS and HIV has driven 12 patients out of their palliative care centre in Bangalore city. Umpteen calls from worried residents of OMBR Layout pushed the Bangalore City Corporation to shut down the AIDS care centre, and move the patients to Isolation Hospital reports Times of India.

The Samraksha care centre was set up on May 12 this year, and 14 people living with HIV/AIDS have reportedly been cared for here. Twelve people living with HIV/AIDS face the immediate risk of being isolated. We are one of the few centres in Karnataka which provide palliative care to people in terminal stages of HIV infection,’’ Samraksha’s director stated. 

But I am also interested in seeing that people do not suffer from psychological trauma. I have received many complaints from residents. The earlier they move the better,’’ Dr Jayachandra Rao says Chief Health Officer of Banglore City Corpration. With tuberculosis on the rise among AIDS patients, there is the danger of people contracting the disease, he said. “The Town Planning and Country Act states that hospitals and nursing homes cannot be located in residential areas. If they want to continue, they must raise the building wall and take care of the waste generated,’’ Dr Rao stated.

You can read the full story at:
http://timesofindia.indiatimes.com/cms.dll/html/uncomp/articleshow?msid=47309513&prtpage=1  

TB India 2003- RNTCP Status Report

Published by: Central TB Division, Ministry of Health and Family Welfare, Nirman Bhavan, New Delhi-110011.

Central TB Division has come out with a 64-page report to document the current progress of RNTCP in India. The report starts with startling facts about impact of TB on the nation, its social and economic burden and links between TB and HIV. It also briefly explains the concept of DOTS and how it is being implemented in India. It is followed by a detailed report on expansion of RNTCP. It profiles those states, which have achieved cent percent coverage with DOTS.

The report outlines the other activities initiated by RNTCP to foster HIV/TB coordination, involvement of private sector, NGOs and Medical Colleges of the country. 

The Status Report includes a number of colorful pictures, which highlight the efforts of Central TB Division to achieve a broad inter-sectoral coordination to support DOTS expansion in India.

Web Call: A visit to the National Tubeculosis Centre, Nepal website.

The National Tuberculosis Centre, Nepal has been in existence since 1992. Its efforts at TB control and creating awareness about the disease and its treatment are highlighted on the website (www.ntp.com.np)

The website elucidates the need of the National TB Control Program in Nepal as also the role of DOTS in achieving the targets set by the WHO. There is a comprehensive explanation of DOTS, its technical and management components and also a compelling statement on why it is the right choice for TB cure in the framework of the Primary healthcare system. Two downloadable annual reports provide a fairly comprehensive idea of the problem of TB in Nepal and the solutions that have evolved over time. The page on TB and SAARC countries provides interesting facts on the occurrence of the disease and the implementation of DOTS in these nations. 

The contents of the website should prove notable for those interested in planning, implementing and monitoring a TB control initiative in the setting of the developing world.