Académique Documents
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Module 5 :
1-82
Programme Monitoring
Module 6 :
83-153
Programme Management
Module 7 :
157-198
201-221
225-244
Table of Contents
Module - 5
Programme Monitoring
Learning Objectives ....................................................................................................................
Follow the Report or Feedback ..................................................................................................
Analysis of the quarterly report of case finding .........................................................................
Quarterly report on sputum conversion ....................................................................................
Quarterly report on treatment outcome ....................................................................................
General Information ...................................................................................................................
Procedure for preparing & reviewing quarterly report on Treatment outcome .......................
TB treatment outcome of HIV positive patients ........................................................................
Report on programme management and logistics .....................................................................
PHI level monthly report on programme management and logistics ........................................
Quarterly report on programme management and logistics TU level .......................................
Quality of DOTS implementation ...............................................................................................
Medications, Consumables and equipments .............................................................................
Quarterly report on programme management and logistics state level ....................................
Analysis of quarterly reports ......................................................................................................
Provision of feedback .................................................................................................................
Method of providing feedback ...................................................................................................
Time Schedule for feedback ........................................................................................................
Record to be used for preparing the reports ..............................................................................
Quarterly report on programme management and logistics state level Format .......................
1
2
10
13
20
22
28
29
33
34
38
40
41
45
49
51
52
52
52
71
MODULE 5
Learning objectives.
Introduction
In the previous module we have learnt about registering of cases in TB register and
monitoring of the treatment of the patient till the declaration of the treatment outcome. In the
ensuing module we will learn how to utilize the information recorded in the TB register for
generation of periodical reports on the programme activities and learn to monitor the
performance of the programme through these reports.
Monitoring: It is a centralized systematic ongoing collection, collation, analysis and
interpretation of the data with a view to detect any deviations from the expected norms
followed by dissemination of feedback information to the peripheral authorities for corrective
actions.
Monitoring is a process of observing whether an activity or service is occurring as planned.
Monitoring aims at identifying any diversion from a planned course of action and allowing
timely solutions to problems In management, the continuous oversight of the
implementation of an activity seeking to ensure that input deliveries, work schedules,
targeted outputs, and other required actions are proceeding according to plan.
Quarterly reports
Under the monitoring system there are four types of quarterly reports. These reports
furnish information on case finding, sputum conversion and treatment outcome of a
quarterly cohort of patients. The fourth one is a quarterly report on the programme
management and logistics report (PMR) generated at different levels PHI (monthly), TU,
District and State.
District TB Centre
Feed Back
Electronic Transmission
Feed back
Central TB Division
State TB Cell
Quarterly Reports
Cohort: In RNTCP, a cohort is a group of patients who were registered for treatment in a
specified area (TU, district, state, country) over a specified period of time (quarterly,
annual). The date of registration in the TB register is used to demarcate the cohort.
The specified quarterly cohort periods are:
Quarter
From
To
First
Second
1st April
30th June
Third
1st July
30th September
Fourth
Preparation and
submission of reports
from PHI
Preparation and
submission of reports
from TU to District
First
7th April
24th April
30th April
7th July
24th July
30th July
Third
7th October
24th October
30th October
Fourth
7th January
24th January
30th January
The quarter under report (eg. 1Q, 2Q, 3Q, 4Q suffixed by calendar year)
Eg. Patients registered during the first quarter will be reported in the first month of
the second quarter to different levels as furnished in the table above.
Name of the TB Unit and its code number (as assigned by CTD)
Name of the reporter (Name of the MO-TC/DTO/STO)
Date of completion of the form (self explanatory)
b. BLOCK 1: This block contains the total number of new and previously treated cases
diagnosed and registered in a particular quarter.
New cases are subdivided into four columns comprising:
Relapse
Failure
Treatment after default
Others
Break-up of cases in the age group 0-14, 15 years and above and their total is provided for
both new and previously treated cases. Sex-wise break up is also provided for all new
cases and relapses among previously treated cases.
Block 1: All new and previously treated patients registered in the quarter.
Age
0-14 Yrs
15 Yrs
Total
Smear
positive
pulmonary
TB
New cases
Previously Treated Cases
Smear
Extra
Treatment
negative
Treatment
pulmonary Others Relapse
After
pulmonary
Failure
TB
Default
TB
Others
Total
Male
Female
Total
c. BLOCK 2: Break up of new smear positive pulmonary tuberculosis cases, age wise and
sex wise is provided in Block 2. This block facilitates drawing inferences on the
epidemiological trend and efficiency of the TB control measures currently in force.
4
15 24
25- 34
35 44
45 - 54
55 64
65
Total
d. BLOCK 3: The programme monitors the proportion of TB patients getting tested for HIV
to know prevalence of HIV infection among TB patients, thus ensuring appropriate HIV
care in TB patients. Block 3 furnishes information on TB-HIV collaborative activities and
provides information on total number of registered TB cases tested for HIV either before
or during treatment and number found to be infected.
Block 3: TB/HIV Collaboration
Of (a)
Number known to be HIV infected
(b)
Procedure for preparing & reviewing the quarterly report on case findings
BLOCK 1:
The pages pertaining to the quarter to be reported & reviewed are located in the TB
register. It can easily be located by going through the pages since the cases are
registered on a new page every quarter. For eg. Patients registered from 1st January
31st March.
Identify new and previously treated TB cases by age and sex in each page. Fill their
exact number in the appropriate box provided under summary at the bottom on the left
side of TB register on each page as soon as the page is completed.
Count the total number of similar cases in all the summary boxes of each page of the TB
register for the age group for the entire quarter. Their exact number (sum) is entered in
the appropriate boxes of the Block 1 of the quarterly report on case finding. For eg.
smear positive cases in the age group of 0-14 years of all the pages for the quarter in
the TB register are added and total of that is recorded in the box in Column 1 against 014 years row. The same procedure is adopted for all the types of cases.
BLOCK 2
This block contains age and sex-wise break up of only new smear positive cases
registered in a specific quarter of Block 1.
The new smear positive cases registered in all the pages pertaining to the quarter of the
TB register are identified in the seven age groups (0-14, 15-24, 25-34, 35-44, 45-54,
55-64, 65 & above) provided in the Block 2. Worksheet provided in the module may be
used for this purpose. These are internationally recognized age groups.
The number of new smear positive cases males, females and total should match with
those reported Block 1
The purpose of this block is to provide information on the process of ascertaining HIV
status of TB patients.
Total number of TB patients whose HIV status is known either before diagnosis or
during diagnosis and treatment is to be reflected in column (a). Enter the sum of all TB
patients registered in the quarter with their HIV status recorded as either positive (P) or
negative (N).
Total number of TB cases found HIV positive either before diagnosis or during diagnosis
and treatment is to be reflected in column (b). The sum of all TB patients registered in
the quarter with their HIV Status recorded as positive (P) in the TB register.
It is to be noted that number of patients known to be HIV positive may be less than the
number that will ultimately be reported in the treatment outcome quarterly report, as it is
expected that some will undergo HIV testing during the course of treatment after the
case finding report is submitted.
EXERCISE 1
Using the five pages of the Tuberculosis Register in Exercise Workbook 3, complete all the
three Blocks of the Quarterly Report on Case Finding. Use the information from the
corresponding summary table at the bottom of the Tuberculosis Register for completing the
worksheets meant for Block 1, 2 & 3 respectively. The total of all types of cases thus
arrived at will be transferred on to the appropriate cells in the block 1,2 & 3 of the quarterly
report on new and previously treated cases.
For completing worksheet, one tally mark (/) is put for each case. Four tally marks are
placed consecutively (////). Subsequently, when a fifth case is recorded four tally marks
already put are crossed (-). In this way each such group represents five cases. This method
of tally marking facilitates counting.
For convenience, easy understanding and execution of the exercise during training, it is
recommended that two trainees may be allotted one page of the TB register for exercise on
case finding. This can be tallied and entered in the Block 1 of the quarterly report on case
findings. This exercise will be facilitated by the facilitator.
Page
Age
No. Group
NSP
M
NSN
M
NEP
Others
1
2
0-14
Yrs.
3
4
5
Total
1
2
15
Yrs.
3
4
5
Total
15 24
25- 34
35 44
45 - 54
55 - 64
65
M
Total
M
1
2
3
4
5
Total
Note: The total number of NSP cases in block 2 should be equal to total of NSP cases in block 1 of the
quarterly report on new and previously treated cases.
Of (a)
Number known to be HIV infected
(b)
Note: TB patients whose HIV status is unknown and for whom information is not available are not to be
included in cell (a).
15 24
25 34
st
0 14
Notes: Quarterly :
Age
Male
Female
Total
55 64
Treatment
Failure
(b)
Total
Total
Others
Of (a)
Number known to be HIV infected
65
Treatment
After Default
45 54
Relapse
35 44
Block 2: New Smear Positive Pulmonary TB cases only: from column above
Male
Female
Total
Block 1: All new and previously treated patients registered in the quarter
New cases
New smear
New smear
New extra
positive
negative
Others
pulmonary TB
pulmonary TB pulmonary TB
0-14 Yrs
15 Yrs
Total
Name of the reporter: ___________________________________ Signature: _______________ Date of completion of this form
Description
Calculation
Numerator:
Annualized/annual
NSP case notification rate X 100
Denominator: Estimated incidence
of smear positive cases /lakh
population
10
Possible Actions
Expected:
Reported:
Ensure that :
New smear-positive
case detection rate:
Case detection
rate of New
smear-positive
cases is less than
50%
at least 70%
11
Proportion of
previously treated
cases has
suddenly dropped
in comparison to
previous quarter.
Ensure that:
Proportion of
previously treated
cases has
suddenly
increased in
comparison to
previous quarter.
Ensure that:
Among New
pulmonary cases,
proportion of
smear-positive is
less than 45%
Ensure that:
Among New
pulmonary cases,
proportion of
smear-positive is
more than 70%
Ensure that:
Diagnostic algorithm is completely followed in
cases with initial two smear negative results.
During field visits, health workers track and
motivate the suspects to get repeat sputum
examined if symptoms persist.
Smear negative patient are not missed during
referral for X-ray chest.
Expected:
Proportion of new
pediatric cases out of
Very low
proportion of
pediatric cases
compared to
Ensure that:
All health care providers including pediatricians are
trained in RNTCP Pediatric guidelines
12
national/state
average
Patients whose sputum smears are still found to be positive at the end of Intensive
Phase, will receive another month of intensive phase of treatment, thereby improving
their chances for cure.
The quarterly report on sputum conversion should be compiled by reviewing the patients
under RNTCP DOTS, who were registered in TB Register 4-6 months earlier. For example,
if the quarterly reports are being prepared on 7th October 2010, the sputum conversion
report should include the sputum smear-positive patients registered in 2nd Quarter 2010
(April to June 2010). These are the patients who were included in the Quarterly Report on
Case Finding of 2nd Quarter 2010.
Calculation of sputum conversion rate involves the following steps:
The number of smear-positive patients of each type put on treatment under DOTS is
obtained from the Quarterly Report on Case Finding for the corresponding quarter.
13
All patients started on treatment are included in the denominator, even if they have
died, defaulted, transferred out, or not had their sputum collected for examination.
Sputum conversion
rate =
100
*For calculating sputum conversion rate for new sputum smear-positive patients only, all those who converted at the end
of IP (at the end of two months) and at the end of extended IP (at the end of three months) should be added to obtain the
numerator. Previously treated Smear positive cases converted at the end of the extended intensive phase (at the end of
fourth month) is excluded from the numerator. This is because collection of this information would delay sputum
conversion reporting by one quarter without adding significant information. Therefore in the sputum conversion report,
there is no provision for reporting sputum conversion at the end of extended IP in previously treated cases.
The sputum conversion rate is not only an indicator of the efficacy of the treatment
regimen, but also of the effectiveness of programme implementation. Hence all efforts
should be made in obtaining the results of the follow up sputum examination at the end of
intensive phase of the patients transferred to different unit/district. Although sputum
conversion rates are determined for all different types of smear-positive patients, the most
important evaluation is that of new sputum smear-positive patients.
At least 90% of new smear-positive patients put on treatment are expected to become
smear-negative within 3 months of treatment.
Ensure that the numbers of new sputum positive cases in the sputum conversion report
matches with the numbers of new smear positive cases registered 4-6 months earlier, as
per the case finding report. Similarly, the numbers of sputum positive Previously treated
cases in the sputum conversion report should match with the total of the smear positive
previously treated cases (Relapse, Failure and TAD) in the corresponding case finding
report.
The sputum conversion rate is not only on indicator of the efficacy of the treatment regimen,
but also of the effectiveness of programme implementation. Hence, all efforts should be
made in obtaining the results of the follow up sputum examination at the end of intensive
phase of the patients transferred to different unit/district. Although sputum conversion rates
are determined for all different types of smear-positive patients, the most important
evaluation is that of new sputum smear-positive patients.
At least 90% of new smear-positive patients put on treatment are expected to become
smear-negative within 3 months of treatment.
Ensure that the numbers of new sputum positive cases in the sputum conversion report
matches with the numbers of new smear positive cases registered 4-6 months earlier, as
per the case finding report. Similarly, the numbers of sputum positive Previously treated
cases in the sputum conversion report should match with the total of the smear positive
previously treated cases (Relapse, Failure and TAD) in the corresponding case finding
report.
Cohort of patients for sputum conversion report:
The cohort of patients registered 46 months earlier will be assessed.
14
TB Register.
Quarterly Report on case finding of the quarter selected for determination of smear
conversion.
Name of the area and code number (TB Unit - Self explanatory)
Name and signature of the reporter (MO-TC/ DTO/ STO)
Date of completion of this form (Not later than 1st week of the 3rd quarter in cases of
patients registered in 1st quarter).
Positive
N.A.*
Positive
N.A.*
Column 1: Total number of patients registered in the quarter being assessed for
conversion is entered in this column (refer table above).
Column 2: Results of the sputum examination conducted at the end of two months (IP)
among new smear positive patients are reported as negative or positive or NA as the
case may be, under the sub-columns. Patients who are not subjected to sputum
examination or whose sputum results are not available for any reason are entered under
the column NA. The above information on the follow up of sputum examination results are
to be picked out from the relevant pages of the TB register pertaining to the quarter to be
reported.
Patients whose sputum results were positive in column 2 and whose intensive
phase was extended by one month are subjected to follow up sputum examination at the
Column 3:
15
Positive
N.A. *
Column 1: Total number of patients registered as relapse, treatment after default and
treatment failure in the quarter being assessed for conversion are entered in this column
(refer table above).
Column 2: Results of the sputum examination conducted at the end of intensive phase
{three months among previously treated smear positive patients (excluding others)} are
reported as negative / positive / NA as the case may be in the table above. Patients who
are not subjected to sputum examination or whose sputum results are not available are
entered under the column NA. The above information on the follow up of sputum
examination results are to be extracted from the relevant pages of the TB register
pertaining to the quarter being assessed.
The basis of calculation of sputum conversion rate:
The conversion rate among new smear positive cases is arrived through proportion of
total number of patients converted to smear negative at the end of 2nd and 3rd month out of
total sputum positive patients registered for treatment in the specific quarter. For example,
If out of the 100 new smear positive patients registered for treatment in the 1st quarter, 85
have become negative at the end of two months and 10 have become negative at the end
of three months, the sputum conversion rate is the cumulative of 85 and 10 i.e., 95 out of
100 = 95%.
The conversion rate among previously treated smear positive cases is arrived through
proportion of total number of patients converted to smear negative at the end of intensive
phase (3rd month) out of total previously treated sputum positive patients registered
(relapse, TAD and failures) for treatment in the specific quarter.
The benefit of arriving at conversion at the end of the extended intensive phase is
applicable only for new cases and not for previously treated cases.
Points to remember
Patients included under sub - column NA at the end of two months of Intensive
Phase should not be reflected again under the sub - column meant for Sputum
results of the positive patients at 3 months
All new and previously treated smear positive patients registered in the particular
quarter must be included in this report.
Sputum conversion of the patients classified as Others under previously treated
cases is not considered in this report.
EXERCISE 3
In Mandya district, the number of New smear-positive patients started on treatment regimen
for new cases was 88. After two months of IP, 61 patients converted to smear-negative, 4
remained smear-positive and 23 did not have their sputum smear examination done. After
the extended IP, the 4 cases which remained smear-positive had their sputum examined
and all had converted to smear-negative.
1.
2.
3.
Positive
N.A.*
17
Positive
N.A.*
EXERCISE 4
Complete the Quarterly Report on Sputum Conversion on the next page using the five
pages in the Tuberculosis Register in Exercise Workbook E3. Use the worksheet provided
below.
Revised National Tuberculosis Control Programme
WORKSHEET
Quarterly Report on Sputum Conversion
Review every page of the TB Register for the quarter being reported on. Ensure that all available
sputum results have been entered into the register. Put a tally mark(/) in the appropriate cell below
and give the totals in the reporting format provided. Every Sputum Positive new, relapse, failure
and treatment after default cases registered must be entered in this report. Only pulmonary
sputum positive tuberculosis cases are included in this report.
One tally mark (/) is put for every case. Four tally marks are placed successively (////). When the
fifth case is recorded, the four tally marks already put in are crossed (-). In this way, each such
group represents five cases. This method of tally marking facilitates counting.
Block 1
Total number of
registered new
sputum positive
patients
(1)
Positive
N.A.*
Positive
N.A.*
Block 2
Total number Previously treated
of sputum -positive cases
registered (excluding others)
(1)
18
Positive
N.A. *
Name of area:
.
Code No. ____________________
Block 1
Total number of
registered new
sputum positive
patients
(1)
Positive
N.A.*
Positive
N.A.*
Block 2
Total number of Previously
treated sputum -positive cases
registered (excluding Others)
(1)
Positive
N.A. *
Indicator
Possible Actions
Conversion
rate is more
than 90% of
new smearpositive
patients at the
end of 3
months
Less than
85% of
New smearpositive
patients
become
sputum
smearnegative at 3
months
In the TUs with low sputum conversion rate, all PHIs should
be intensively supervised to identify whether:
1. Follow up sputum examination is not done in large
number of patients, then
Ensure that:
All MO PHI and staff ensure timely follow up sputum
examination of every patient under treatment.
Sputum cups are made available to all DOT providers with
clear instruction on the dose when the cups need to be
provided to the patients for follow up.
Patients who interrupt treatment, die or transferred out are
minimized.
2. Many patients remain sputum positive, then
Ensure that:
Accurate history-taking regarding previous treatment for TB
from any source is elicited for proper categorization and
efficient treatment. It should be explained to patients that
only if they provide accurate information, the most effective
treatment can be given. Proper classification and
categorization of cases is a pre-requisite for efficient
treatment.
Sputum microscopy is of good quality. Slides of patients
who remained smear positive at the end of the intensive
phase should be reviewed.
Every dose of medication is observed during the intensive
phase of treatment. DOT Centre should be convenient to
the patient and treatment interrupters are promptly
retrieved back.
The quality of DOTS should be checked at the time of
supervision, including checking of entries in the Treatment
Cards with the drugs available in patient-wise boxes.
20
It is important to know that enhancing case detection be attempted only after achieving and
maintaining 85% cure rate among new smear positive cases. The only means by which
85% or more cure rate can be achieved on a programme basis is by adopting the DOTS
strategy.
The cure rate achieved for new pulmonary smear-positive cases registered in the
Tuberculosis Register under DOTS is a useful indicator to evaluate the effectiveness of
chemotherapy in treating tuberculosis cases.
The smear-positive previously treated cases are also evaluated in a similar manner. Smearnegative pulmonary cases are evaluated separately. Smear-negative pulmonary cases that
have successfully completed their treatment and have not become smear positive during
the course of treatment are declared as treatment completed.
Findings of reports on treatment outcomes help in supervising services of health workers
and monitoring of the programme. Sharing the reports on the results of treatment with
health workers can help them understand how their efforts have improved the cure rate. If
the cure rate of 85% has been achieved, it will make them proud of the work they have
done and hence, motivate them to maintain it. Cure rates should not be calculated for
individual health facilities within TB Units. This is because the number of cases may be too
low to give correct information.
At the beginning of each quarter, the Quarterly Report on Treatment Outcome of
Tuberculosis Patients Registered 1315 Months earlier will be completed (Hereafter,
referred to as Quarterly Report on Treatment Outcome). It summarizes the results of
treatment of patients under DOTS who were registered in the Tuberculosis Register 1315
months earlier. It is the most important report in the routine reporting system of tuberculosis
cases with respect to outcome of their treatment.
This section of the module helps you in knowing how to complete this report. We will learn
how to obtain the information from the Tuberculosis Register, how to summarize the data
and to enter the data into the appropriate columns of the report. We will also learn how to
cross-check the number of cases on this form with data reported earlier in the Quarterly
Report on Case Finding.
For the purpose of preparing the quarterly report on treatment outcome, only the
cases put on DOTS regimen are evaluated .The cases put on Non-DOTS regimen
are not considered for this report.
21
General information
Cohort of patients to be considered: In this report, outcome of patients registered in the
quarter during 13 15 months earlier will be assessed. This facilitates the patients put on
any category of treatment including those whose intensive phase is extended for one
month, to complete the entire period of treatment, sufficient time for collection and collation
of information and for updating the TB register. For example, Cohort of patients put on
regimen for previously treated patients (requiring maximum duration of treatment) during
the first quarter of 2010 (January March 2010) would have completed their treatment
including extension of intensive phase and missed doses by the first quarter of 2011
(January March 2011) and will become eligible for assessment of treatment outcome and
reporting in the first week of the second quarter 2011 (Refer table below).
Cohort of patients registered in the Quarter and the time of reporting
Registered
During
Name of the area and code number (TB Unit) This is self explanatory
Name and signature of the reporter (MO-TC/ DTO/ STO) This is self explanatory
Date of completion of this form This is self explanatory
This report has three blocks labelled as A, B & C. Block 'A' contains information on
treatment outcome of new and previously treated cases, B contains information on the
treatment outcome of TB patients who are co-infected with HIV and C provides information
on the total number of HIV positive TB patients and number of patients who are provided
with CPT and ART.
22
Patient
reported
during
quarter**
(a)
Treatment Outcome
(c)
Type of patient
(b)
NEW CASES
Smear Positive
NSP
Cured
Treatment
completed
Died
Treatment
Failure
Defaulted
Transferred
out
Switched
over to
MDR-TB
treatment
7
Total
number
evaluated
(sum of 1
7)
(d)
Total
Male
Female
Smear Negative
Extra pulmonary
Others
Total new cases
PREVIOUSLY
TREATED CASES
Smear Positive
Relapses
Smear Positive
Treatment Failure
Smear Positive TAD
Others
Total Previously
treated cases
* The Reporter is the Medical Officer responsible, not the person completing this form.
** Of these_____________ (number) were excluded from evaluation of treatment outcome (Annexe details with the hard copy).
Block 'A' provides information on the treatment outcome of new and previously treated
cases.
Column (a): This column provides information on the total number of different types of
patients reported in the relevant quarter selected for determination of the treatment
outcome. For example, the cohort of patients diagnosed and put on treatment in 1st quarter
of 2010 will be taken up for determination of treatment outcome in the first week of 2nd
quarter of 2011, so on and so forth with other types of cases also.
Column (b): Provides information on types of patients under the following two sub-heads
New cases- comprises smear positive, smear negative, extra pulmonary, others and total
new cases. Sex wise break up of new smear positive cases is also provided under this
column.
Previously treated cases comprises smear positive relapses, smear positive failures, smear
positive treatment after default, others and total of all previously treated cases.
Column (c): There are seven sub - columns for seven possible treatment outcomes
namely, cured, treatment completed, died, failure, defaulted, transferred out and switched
to MDR-TB Treatment Regimen. The relevant treatment outcome will be indicated against
the types of patients. It is pertinent to remember that patient will have only one treatment
outcome.
Column (d): This will reflect the total number of cases evaluated against each type of
cases registered.
23
Total No.
known to
be HIV
infected
Treatment outcomes
Cured
Treatment
completed
Died
Treatment
Failure
Defaulted
Transferred
out
Switched
over to
MDR-TB
treatment
NSP
All TB
Cases
Block 'B' has got three columns. It deals with the treatment outcomes of the HIV positive TB
patients. This provides information on number of new smear positive cases and all TB
cases who are known to be HIV positive and their different treatment outcomes.
Block C: CPT and ART
Block 'C' furnishes information on total number of TB patients known to be HIV infected and
number of those who are on CPT and ART.
Indicators for linkage of HIV positive TB patients to CPT / ART HIV care
1.
2.
EXERCISE 5
Next to the dates given below for the first week of a new quarter, write the months you
would report on in the Quarterly Report on Treatment Outcome.
Date of reporting
1 April 2010
1 July 2010
1 October 2010
1 January 2011
1 April 2011
EXERCISE 6
Using the worksheets on the following pages, complete the Quarterly Report on Treatment
outcome for the five pages of the Tuberculosis Register in Exercise Workbook E3. The
Quarterly Report on Treatment outcome follows the worksheets. Separate worksheets have
been provided for completing block A (two worksheets), block B and C (one worksheet
24
Page
No.
1
2
Smear
positive
cases
3
4
5
Sex
Cured
Treatment
completed
Died
Treatment
Failure
Defaulted
Transferred
out
Switched
over to
MDR-TB
treatment
Total
number
evaluated
M
F
M
F
M
F
M
F
M
F
1
Smear
negative
cases
2
3
4
5
1
Extra
pulmonary
2
3
4
5
1
2
Others
3
4
5
Total
*One tally mark (/) is put for every case. Four tally marks are placed successively (////). When a fifth case is to
be recorded the four tally marks already put in are crossed (////). Such a group represents five cases. This
method of tally marking facilitates counting.
25
Page
No.
Smear
Positive
relapses
1
2
3
4
5
Smear
Positive
Treatment
failure
1
2
3
4
5
Smear
Positive TAD
1
2
3
4
5
Others
1
2
3
4
5
Cured
Treatment
completed
Died
Treatment
Failure
Defaulted
Transferred
out
Switched
over to
MDR-TB
treatment
Total
number
evaluated
Total
Type of TB
cases
NSP
All TB
Cases
Page
No.
1
2
3
4
5
1
2
3
4
5
Total
No.
known
to be
HIV
infected
Treatment outcomes
Cured
Treatment
completed
Died
Treatment
Failure
Defaulted
Transferred
out
Switched
over to
MDR-TB
treatment
BLOCK C : Worksheet for CPT and ART for HIV positive TB patients
Page No.
1
2
3
4
5
Total
# During TB treatment
26
Male
Female
Total
Smear Negative
Extra pulmonary
Others
Total new cases
PREVIOUSLY TREATED CASES
Smear Positive relapses
Smear Positive Treatment failure
Smear Positive Treatment after
Default
Others
Total Previously treated cases
NEW CASES
Smear Positive
NSP
Type of patient
Treatment
completed
2
Died
4
Treatment
Failure
5
Defaulted
NSP
All TB Cases
Type of TB
cases
Total No.
known to
be HIV
infected
Cured
Treatment
completed
Treatment outcomes
Died
Treatment
Failure
Defaulted
Switched over
to MDR-TB
treatment
Switched
over to MDRTB treatment
7
# During TB treatment
Total No. of
TB patients
known to be
HIV infected
No. give
CPT#
No.
given
ART#
Total number
evaluated
(sum of 1 7)
Transferred
out
Signature:
Transferred
out
* The Reporter is the medical Officer responsible not the person completing this form.
** Of these_____________ (number) were excluded from evaluation of treatment outcome (Annexe details with the hard copy).
Patient
reported
during
quarter**
Cured
quarter of __________
TB Register
Previous quarterly Report on case finding of the quarter selected for determination of
treatment outcome (i.e., patients registered 13-15 months earlier)
M
F
Treatment outcome
Cured Treatment Failure Defaulted Died Transferred
completed
out
NSN
NEP
New Others
Relapse
TAD
Treatment
Failure
Previously
treated
others
28
Switched to MDR-TB
Treatment regimen
Total No.
known to
be HIV
infected
Treatment outcomes
Cure
Treatment
Completed
Died
Treatment
failure
Default
Transfer
out
Switched
over to
MDR-TB
Regimen
NSP
All TB
Cases
Block C: In this block, total number of TB patients who are HIV positive and number of
such patients put on CPT and / or ART is reported. This information has to be extracted
from individual patients, registered in the TB register.
Total No. of TB patients
known to be HIV infected
# During TB Treatment
The proportion of HIV positive TB patients receiving CPT and/or ART shows the efficacy of
the programme to provide HIV care for the TB patients.
Points to remember
The number in the column 1 of the quarterly report on treatment outcome should
match with the total number in the corresponding report on case finding for each
type of cases
If for any reason, any of the patients registered is excluded from the evaluation, it
should be substantiated with recorded evidences.
29
The summary at the bottom on the right hand side of the TB register should be
updated periodically. This will facilitate generation of quarterly report on treatment
outcome.
Discussion with health workers and their supervisors on the practice of administering
treatment and providing health education may be helpful in improving the cure rates. It is
to be ensured that health workers directly observe the drug intake by patients, especially
in the intensive phase. During the continuation phase, the first dose of every week
should be directly observed and the empty blister pack checked for the remaining doses
before giving medicines for the next week. Proper health education need to be imparted
to the patients on the importance of taking DOTS.
Interaction with patients should ensure that they understand their treatment regimens
and they need to take directly observed treatment. In addition, whether they have been
categorized properly based on past history of anti-TB treatment needs to be confirmed.
Discussion with the District TB Officer, Medical officer in-charge of health facilities and
MOs for arriving at reasons for low cure rate and remedial actions to be taken.
The table on the following page summarizes some possible causes of high rates of deaths,
failures, defaulters and transferred out cases leading to poor cure rates. (This is only
illustrative and not an exhaustive list.)
30
Expected:
Less than 3%
of New smearpositive
patients are
given the
outcome as
Treatment
completed.
Indicator
Possible Actions
Cure rate of
New smearpositive
patients
is less than
80%
Ensure that:
Visit to centres with low cure rates for discussion with
staff and patients to find out the reasons for low cure rate
and possible solutions.
It is to be ensured that elicitation of accurate history is
taking place at all levels. Patients must be asked
carefully about any prior treatment for tuberculosis taken
from any source. It should be explained to patients that
only if they provide accurate information, the most
effective treatment can be given. If previously treated
patients are not given the regimen for previously treated
cases, they may not respond well to treatment.
It is to be ensured that case definitions are applied
correctly. Any smear-positive patient treated for more
than one month in the past, with default of more than two
months, should receive the previously treated regimen.
It is to be ensured that every dose of medication is
observed during the intensive phase of treatment, and at
least one dose per week in the continuation phase.
Return of empty blister packs during weekly collection of
drugs should be insisted on. DOT centres should be
convenient for the patient.
It may be ascertained that health workers are
administering DOT as per guidelines.
Follow-up sputum smear examinations are done
according to guidelines.
Cure rate of
New smearpositive new
patients is
more than
95%.
New smearPositive
patients who
are reported
as treatment
completed is
more than 3%
31
New smearpositive
patients who
die during
treatment is
more than 5%
Expected:
Failure: Less
than 4%
of New smearpositive
patients
continue to be
smear-positive
at 5 months or
more
New
smear-positive
patients
who fail
treatment is
more than 4%
32
Default rate of
smearpositive new
patients is
more than 5%
Expected:
Transferred
out is less than
3%
Patients who
are
Transferred
out is more
than 5%
Ensure that:
Transfer out can be a way of disguising default. Patients
should be categorized as Transferred out only if they
have been given a Transfer Form to be taken to the
facility where they are transferred. The feedback of
results of follow up sputum examinations and treatment
outcome are reviewed.
Apart from these it is very important to analyse the cure rates, default rates, death rates and
failure rates of previously treated patients (relapses, failures and TAD) to study the
differences and trend of these various outcome indicators.
This report is generated on a monthly basis at PHIs and on quarterly basis at TU, district
and state level. The monthly PHI reports are consolidated on quarterly basis at the TU
level. The quarterly TU level reports are further consolidated at District & in turn at the State
Level. This report facilitates monitoring of logistics and other management activities
involved in successful implementation of TB control activities.
33
General information
Medications - Stock of drugs & requirement
Supervisory activities
IEC/ACSM
Referral activity
Microscopy activity
Treatment initiation
MDR TB case finding activity
Consumables and laboratory requirements to be furnished by DMC.
Equipments
This report is to be prepared after physical verification of stock on the last working day of
the month by the MO of the PHI with the assistance of the concerned PHI staff. The report
has to be sent to the CDHO/CDMO with a copy to the TB unit on or before the fifth of next
month. A copy of the report is marked to the DTO for monitoring. The copies sent to the TU
level is used for monitoring as well as preparation of quarterly report on programme
management and logistics for the TU level.
General information: Details such as name of the PHI, TU, district, month and year of
report are to be recorded under this section.
Medications:
This section has to be filled up by all the PHIs. The information regarding the stock at the
beginning of the month, stock received & consumed during the month, stock at the end of
the month and stock requested have to be arrived at. This is done by reviewing the stock
register maintained for the drug boxes and actual physical stock available. The same
procedure is applicable even for loose drugs and streptomycin injections. The tables
mentioned below are self explanatory and have to be filled up accurately by the person
responsible for maintenance of the drug boxes and DOT administration at the PHI.
34
Note:
1. All PHCs/ CHCs/ referral hospitals/ major hospitals/ specialty clinics/ TB hospitals/ Medical colleges to
submit their monthly reports in this format.
2.
PHIs without DMCs have to fill only the relevant details on page 2.
Name of Peripheral Health Institution: _______________________________________________________
TU: ______________________
District: ____________________
Month: ______________________
Year: ______________________
Medications
Adult Patient Wise Boxes
Stock on first
day of month
(a)
Item (PWB)
Stock received
during month
(b)
Patients
initiated on
treatment
(c)
Regimen for
New patients
(NT)
Stock on last
day of month
(d)=a+b-c
Quantity
Requested (e)=
(c X 2) d
Regimen for
previously
treated patients
(PT)
Stock on
first day of
month
(a)
Stock
received
during
month
(b)
Consumption
during month
(c)
Stock on last
day of month
(d) =(a+b)-c
Quantity Requested
(e) =(cX2) d
Prolongation
pouches (Pouches
each with 12 blister
strips)
Streptomycin 0.75 g
(vials)
INH 300mg
INH 100mg
Rifampicin
150 mg
Ethambutol
800 mg
Unit of
measurement
Tablets
Tablets
Capsules
Stock on
first day of
month
(a)
Stock
received
during month
(b)
Tablets
35
Patients
initiated on
treatment
(c)
Stock on last
day of month
d=(a+b)-c
(d)
Quantity
Requested
e=(cx2)-d
(e)
nd
DTO/2
MO-DTC
MO-TC
STS
STLS
IEC/ACSM:
Number of TB patient provider meetings and community meetings held in the reporting
month is to be entered here. (Refer to the section on ACSM in module 6)
IEC:
Referral activity: This has to be filled up by PHIs referring TB suspects to the DMCs for
sputum examination. This information will be obtained from the OPD register/records
maintained at PHI.
a) The number of new adult out patients attending the health institution is to be
recorded.
b) The total number of TB suspects (out of new adult out-patients mentioned above)
referred for sputum examination has to be mentioned in this section.
Referral Activity (To be filled in by all PHIs from OPD Register)
a.
b.
Microscopy activity: This section has to be filled up by PHIs which are Designated
Microscopy Centres. Laboratory register is the source of information. The following
information is recorded in this section:
c) The number of TB suspects examined for diagnosis (including the suspects
referred from PHIs other than DMC linked to this DMC).
d) The number found smear positive among the above patients (d)
e) The number of TB suspects subjected to repeat sputum examination for diagnosis
f) The number found smear positive among repeat examination ('f' out of 'e')
g) Total number of smear positive cases diagnosed (d + f)
Microscopy Activity (To be filled in by only PHIs which are DMCs from Laboratory Register)
c.
d.
e.
f.
g.
36
g) put on DOTS
g) put on RNTCP Non-DOTS
g) referred for treatment to other TUs
g) referred for treatment outside the
Treatment Initiation (To be filled in by only PHIs which are DMCs from Laboratory Register and
Referral for Treatment Register)
h.
i.
Of the number of smear-positive patients diagnosed (g), number put on RNTCP NonDOTS (ND1 and ND2)
Of the smear-positive patients diagnosed (g), the number referred for treatment to
other TUs within the district
k.
Of the smear-positive patients diagnosed (g), the number referred for treatment
outside the district
Consumables and Laboratory requirements: This has to be filled by PHIs which are
DMCs. Information regarding sputum containers has to be filled by all PHIs (even by PHIs
which are not DMCs and have been supplied with sputum containers). Laboratory Stock
registers maintained for consumables will be used to record the information in the table
which is self explanatory. Universal containers for C&DST are to be entered only if the DMC
has stock of it.
37
Unit of
Measurement
Sputum
containers*
Nos.
Universal
containers for
C & DST
Nos
Slides
Nos.
Carbol Fuchsin
(1% solution)
Litres
Methylene Blue
(0.1% solution)
Litres
Sulphuric Acid
(25% solution)
Litres
Phenolic
solution (for
disinfection~40% pure
solution)
Litres
Immersion oil/
Liquid Paraffin
(Heavy)
mL
Methylated
Spirit
Litres
Stock on
first day of
the Month
Stock
received
during the
Month
Consumption
during the
Month
Stock on
last day of
the Month
Quantity
requested
* PHIs that are not DMCs, but have been supplied with sputum containers, should complete this row.
Equipments: This information has to be provided by PHIs which are DMCs. The position
regarding the number of microscopes available, irrespective of whether it is supplied under
RNTCP or other programmes and their functional status is recorded in this block.
Equipment in place (To be filled in by only PHIs which are DMCs)
Item
Number in
place
In working
condition
Binocular microscopes
Name of officer reporting (in Capital Letters) :
Signature:
Date:
Example:
Referral, microscopy and treatment activities of all PHIs including microscopy centres under
a TU during one quarter is furnished below:
Referral Activities
a.
Number (%) of PHIs referring >2% of new adult OPD patients for
sputum examination
4 out of 16
(25%)
Microscopy Activities
b.
2250
c.
215
d.
150
e.
15
f.
230
39
Out of the smear-positive patients diagnosed (f), number put on DOTS within
the TU
200
h.
12
i.
Out of the smear-positive patients diagnosed (f), the number referred for
treatment to other TUs within the district
05
Out of the smear-positive patients diagnosed (f), the number referred for
treatment outside the district
05
In the example, there were 10 smear-positive patients who are residents of areas outside
the TU. It may also be seen that 8 smear-positive patients [(f) (g+h+i+j)] who have neither
been referred for treatment outside TU area nor put on treatment under RNTCP. It is the
responsibility of the MOTC, STS and STLS to put them under treatment through the
concerned PHIs as soon as possible.
The DTO will ensure through TU level staff that all patients referred between TUs within the
district are put on treatment and reported appropriately.
MDR-TB case finding activity:
It is a consolidation of the PHI monthly report
Referral Activities
Microscopy Activities
Quality of DOTS implementation
Consumption of Medications and Consumables
Information on equipments at TB Units
MDR TB suspects identified
But has not been placed on either RNTCP DOTS treatment regimen or RNTCP nonDOTS treatment regimen and
4th quarter
Performance of DMCs
Only DMC C has High False Results
How to Report
Number (%) of DMCs having High
False Results: 1/10 (10%)
DMC B and DMC E have High False Number (%) of DMCs having High
Results
False Results: 3(30%)
DMC C has High False Results
Number (%) of DMCs having High
False Results: 3(30%)
DMC C has already been included in
1st quarter so not counted again
No DMC has High False Results
Number (%) of DMCs having High
False Results: 3(30%)
43
The number of Medical Colleges and TB Hospitals in the government and private
sectors are reported in this section. The number of these institutions having an
RNTCP facility is reported separately. The Medical Colleges having an RNTCP
facility are usually provided with some minimum staff on contractual basis. The
details of such staff appointed in the Medical Colleges are also to be reported in
this section.
14.2
14.3 In the table for other sector involvement, the number present in the district and
number implementing RNTCP is reported. In order to obtain the number of such
institutions in the district, the DTO needs to Consult the relevant authorities, e.g.
Railways, ESI, Home department for prisons, Corporate sector management etc.
44
Basic RNTCP services: Number of districts, STDCs, state drug stores, TB units,
DMCs, accredited DST labs, DOTS Plus centers/providers and sputum collection
centers existing under public / private sector, NGOs, Medical Colleges are
indicated in this section. Besides, the number of quarterly reports on case finding,
sputum conversion, treatment outcome, programme management and logistics,
report on infrastructure and activities of STDCs, state Task Force on medical
colleges, State Drug Stores, report on DOTS plus are enclosed along with this
report.
2.
3.
Referral activities: Under this, the percentage of PHIs referring 2% and above of
adult outpatients for sputum examination is reported.
4.
5.
Treatment initiation: In this section, number of patients put on DOT within the
district, number of patients put on RNTCP non DOTS regimen and smear positive
patients diagnosed but referred for treatment outside the district are reported.
6.
MDR-TB case finding activity: Under this section, total number of MDR-TB
suspects identified and number of MDR-TB suspects from whom sputum was
collected and transported to diagnostic laboratory are indicated here.
7.
9.
Staff position at State level: Category of staff, number sanctioned , staff both
regular and contractual in place under RNTCP total in place and trained and
number trained and retrained are indicated under this section. The position and
training status of state head quarters staff are also to be reported. The complete
details of the state level training conducted by STDC and State TB Cell are also
reported in the relevant section.
10. Equipments in the state headquarters and STDC: Equipments available in the
state headquarters and STDC are reported with that of the districts. The working
condition of the equipments and the status of AMC of binocular microscopes and
IRL equipments are also reported. The status of state drug store, arrangement in
place for the transportation of drugs from the SDS to the districts are also reported
here.
11. Medication: The details of patient wise drug boxes meant for new and previously
treated cases. Information on prolongation pouches and injection SM, pediatric
drugs, and RNTCP loose and second line drugs are indicated under this section.
12. The TB-HIV collaboration activities: Under this heading whether co-ordination
committee meeting is held or not. If yes, minutes of the meeting are attached or
not, number of TB-HIV TWG meeting held during the quarter and information on
receipt of ICTC reports from SACS are indicated.
13. Participation of medical colleges and TB hospitals: Under section the number
of medical colleges and TB hospitals both government and private participating in
RNTCP are indicated. Besides, staff provided on contractual basis by the
programme is also indicated. In addition, information on NGOs and private
practitioners participating in RNTCP, the nature of scheme adopted by them are
also furnished. Involvement of other sections like ESI, railways, CGHS etc., are
also recorded in this section.
14. IEC/ACSM activities: Under this section the name of the activity and the number
implemented under each activity are furnished
15. Financial Management: In this section the following information are recorded.
The latest month and year for which all RNTCP contractual staff at the state
have been paid remuneration is reported as month/year.
The latest month and year for which all RNTCP contractual staff of all the
districts have been paid remuneration is reported as month/year.
The latest month and year for which all RNTCP contractual staff of all the
districts have been paid vehicle maintenance/POL is reported as month/year.
46
Period for which NGOs/PPs with signed schemes were paid as per MOU in all
districts is to be reported as month/year.
47
Description
Calculation
%
of
smear Proportion of suspects who are diagnosed
positive
patients as smear positive cases and is expressed
amongst suspects as a percentage
Percentage
of Proportion of patients who were diagnosed
initial defaulters
with smear positive TB in the lab register,
but have not been put on DOTS, non DOTS
or referred to other district for treatment
among all diagnosed smear positive cases
in the district.
Percentage
of
smear
positive
cases
having
started on RNTCP
DOTS with in 7
days of diagnosis
Percentage
of
cured
smear
positive
cases
having
end
of
treatment follow-up
sputum done within
7 days of last dose
Staff Position
Trained manpower
Equipments
Proportion
condition
Suspects
examined
per
smear
positive
cases diagnosed
of
equipment
in
48
Number of equipment in
working Numerator:
working condition
Denominator:
Total
number
of
equipment.
Relapses
Previously treated
Extra-pulmonary
Relapses
Trends in case notification rates over a period of time also should be reviewed. Annualized
case notification rate is calculated by multiplying the number of cases registered in a
quarter by 4 and dividing by the mid-year population in lakhs.
Case detection rate: It is the proportion of cases detected out of the estimated cases in
the district or state. New smear-positive case detection rate for a year, is calculated by
dividing the number of New smear-positive cases registered during the year by the
estimated incidence of smear positive cases for that population and multiplying it by
hundred. This is calculated by dividing annualized/annual NSP case notification rate
per lakh population by the estimated NSP cases per lakh population per year. For the
national level the estimated NSP case notification is 75/lakh population per year as
per the 2003 estimate. At least 70% of the expected new smear positive cases are to be
detected and placed on treatment, under RNTCP, as per the objectives of programme
For example, fifty (50) new smear positive cases have been detected per lakh per year in a
particular district out of 75 estimated. Thus the case detection rate works out to 50/75 x 100
= 66%
While analyzing the case notification rates, give special attention to the denominator, i.e.
the population. If the population given is not correct, then the rates may not reflect the
reality. Again it is not appropriate to calculate NSP case notification rate below the level of
districts as the small population denominator and other population characteristics will lead
to incorrect interpretations as far as case detection is concerned. In such circumstances, it
is better to use other indicators for case detection efforts like suspects examined per lakh
population, suspects examined per smear positive case detected, sputum positivity rate etc.
If the trend of new smear positive case notification rate is showing a decline in a district,
look at the trend of suspects examination rate, suspects examined per smear positive case
diagnosed, trend of proportion smear positive retreatment cases among all smear positive
cases, trend of proportion of new smear positive cases among all new pulmonary cases
etc. Process indicators like the proportion of medical officers and laboratory technicians in
place and trained, proportion of DMCs with high false errors etc need to be looked at and
linked to the programme performance indicator.
50
Provision of feedback
Providing proper feedback will promote improvement in the accuracy and promptness of
reporting. Feedback indicates to the field personnel that the information they collect is used
and appreciated. It should be always remembered that, health workers efficiently
implementing the programme as per the guidelines should always be complimented. When
the analysis indicates problems with the data, the same is investigated and solutions sought
for remedial action.
Feedback - contents:
Appreciation and compliments for the task accomplished and encouragement for
future progress.
51
letters summarizing the findings of the report and appropriate summary tables and
charts on a quarterly basis;
Summary of key indicators, possible causes, and possible responses to problems are given
in earlier pages of this module.
First
30th June
Second
30th September
Third
31st December
Fourth
31st March
Quarter
TB Suspects examination
Rate
Suspects examined per smear
positive case diagnosed
Formula
(Total Cases registered during the quarter X4)
Population in Lakhs
(Total New smear positive cases registered during the quarter
X4)
Population in Lakhs
ANSP CNR X 100
Estimated incidence of smear positive cases for that area
NSP X100
NSP+NSN
(From Block-1 of case finding report)
NEP X100
NSP+NSN+NEP+new Others
(From Block-1 of case finding report)
S+ve previously treated cases X 100
NSP+ S+ve previously treated cases
(From Block-1 of case finding report)
NSP cases converted at 2 months and 3 months X100
NSP cases registered during the quarter
(From Quarterly report on sputum conversion of new and
previously treated cases registered 4-6 months earlier)
NSP Cases Cured X100
NSP cases registered
(From Quarterly report on treatment outcome of new and
previously treated cases registered 13-15 months earlier)
(NSP Cases Cured + NSP Cases treatment completed) X100
NSP Cases Registered
(From Quarterly report on treatment outcome of new and
previously treated cases registered 13-15 months earlier)
TB suspects examined in the quarter/year
Population in Lakhs
(From Quarterly Report on Programme management)
TB Suspects examined
Smear positive cases diagnosed
(From Quarterly Report on Programme management)
(Total Number of smear positive cases diagnosed in the district (Number of smear positive cases started on DOTS/Non DOTS
with in the district + number of smear positive cases referred for
treatment out side the district)) X 100
Total Number of smear positive cases diagnosed in the district
53
# Number
Block 2: New Smear Positive Pulmonary Tb cases only: from column above
Age
0 14
15 24
25- 34
35 44
Male
Female
Total
Male
Female
Total
Block 1: All new and previously treated patients registered in the quarter
New cases
New smear
New smear
New extra
Others
positive
negative
pulmonary TB
pulmonary TB pulmonary TB
0-14 Yrs
15 Yrs
Total
55 - 64
Treatment
Failures
65
Treatment
After Default
Total
Total
Others
Of (a)
Of all Registered TB cases,
Number known to be HIV
Number known to be tested for
Identification
the
infected
HIV before number
or duringofthe
TBarea.
treatment
(b)
(a)
45 - 54
Relapse
Name of the reporter: ___________________________________ Signature: ____________________ Date of completion of this form
Name of area:
.
No. _____________________
Positive
N.A.*
Positive
N.A.*
Block 2
Total number of sputum -positive
Previously treated cases
(excluding others)
55
Positive
N.A. *
Male
Female
Total
Smear Negative
Extra pulmonary
Others
Total new cases
PREVIOUSLY TREATED CASES
Smear Positive relapses
Smear Positive Treatment failure
Smear Positive Treatment after
Default
Others
Total Previously treated cases
NEW CASES
Smear Positive
NSP
Type of patient
Treatment
completed
2
Died
4
Treatment
Failure
5
Defaulted
NSP
All TB Cases
Type of TB
cases
Total No.
known to
be HIV
infected
Cured
Treatment
completed
Treatment outcomes
Died
Treatmen
t Failure
Defaulted
Switched
over to MDRTB treatment
Transferred
out
Total
number
evaluated
(sum of 1
7)
# During TB treatment
No. given
CPT#
No. given
ART#
Switched
over to MDRTB treatment
Total No. of TB
patients known to
be HIV infected
Transferred
out
Signature:
* The Reporter is the medical Officer responsible not the person completing this form.
** Of these_____________ (number) were excluded from evaluation of treatment outcome (Annexe details with the hard copy).
Patient
reported
during
quarter**
Cured
quarter of __________
District: __________________
Month: ______________________
Year: __________________
Medications
Item (PWB)
Stock received
during month
(b)
Patients initiated
on treatment
(c)
Stock on last
day of month
(d)
=a+b-c
Quantity
Requested
(e)
= (c X 2) d
Regimen for
New patients
(NT)
Regimen for
previously
treated patients
(PT)
Stock on
first day of
month
(a)
Stock
received
during
month
(b)
Consumption
during month
(c)
Stock on
last day of
month
(d)
=(a+b)-c
Quantity
Requested
(e)
=(cX2) d
Prolongation pouches
(Pouches each with 12
blister strips)
Streptomycin 0.75 g (vials)
Stock on
first day of
month
(a)
Stock
received
during
month
(b)
57
Consumption
during month
(c)
Stock on last
day of month
(d)
=(a+b)-c
Quantity
Requested
(e)
=(cX2)-d
Supervisory Visit by
DTO/2
MO-DTC
MO-TC
STS
STLS
IEC:
Number of TB Patient Provider meetings held
Number of Community meetings organized
b.
Microscopy Activities
(To be filled in by only PHIs which are a DMC from Laboratory Register)
c.
d.
e.
f.
g.
Treatment Initiation
(To be filled in by only PHIs which are a DMC from Laboratory Register and Referral for Treatment Register)
h.
i.
Of the number of smear-positive patients diagnosed (g), number put on RNTCP NonDOTS (ND1 and ND2)
Of the smear-positive patients diagnosed (g), the number referred for treatment to
other TUs within the district
k.
Of the smear-positive patients diagnosed (g), the number referred for treatment outside
the district
(To be filled in by only PHIs which are a DMC from Laboratory Register)
Number of MDR-TB suspects identified
Laboratory Consumables
Unit of
Measurement
Nos.
Stock on first
day of Month
Stock received
during Month
Nos
Nos.
Litres
58
Consumption
during Month
Stock on last
day of Month
Quantity
requested
Litres
Immersion oil/
Liquid Paraffin
mL
Methylated Spirit
Litres
(for disinfection-~40%
pure solution)
Litres
Litres
(Heavy)
* PHIs that are not a DMC, but have been supplied with sputum containers, should complete this row.
Number in place
In working condition
Binocular microscopes
Signature:
Date:
59
State: _________
Quarter:
Year: ___________
Public Sector
(including Govt. /
Corporation Medical
Colleges, Govt.
health dept., other
Govt. dept. and
PSUs)
NGOs
Community
Volunteers
Total
Number of DMCs
Number of Sputum
collection centres
Number of DOT
Centres/providers
Number of PHIs expected to submit monthly PHI reports
Number of PHIs that submitted monthly PHI reports for all 3 months in the quarter
The following reports are enclosed (Tick [] to indicate that the report is enclosed)
Supervisory activities (to be compiled from PHI reports and tour diaries)
Type of Unit
Referral Activities
a.
Number (%) of PHIs referring > 2% of new adult out patients for sputum examination
Microscopy Activities
b.
c.
d.
60
STS
STLS
f.
Treatment Initiation
g.
Of the smear-positive patients diagnosed (f), number put on DOTS within the TU
h.
Of the number of smear-positive patients diagnosed (f), number put on RNTCP Non-DOTS (ND1
and ND2) within the TU
Of the smear-positive patients diagnosed (f), number referred for treatment to other TUs within the
district
j.
Of the smear-positive patients diagnosed (f), number referred for treatment outside the district
Number (%) of all Smear Positive patients started on RNTCP DOTS treatment within 7 days of
diagnosis (Information from TB Register)
2.
Number (%) of all Smear Positive patients registered within one month of starting RNTCP DOTS
treatment (Information from TB Register)
3.
Number (%) of all cured smear positive patients* having end of treatment follow-up sputum
examination done within one week of last dose (Information from TB Register)
4.
Number (%) of patients (all forms of TB) registered during the quarter receiving DOT through a
community volunteer (Information from TB Register)
* These cases should be from the same quarterly cohort which have been included in the report on Results of Treatment
Medications
Adult Patient Wise Boxes
Item
Unit of
Measurement
Regimen for
New
Patients
(Cat-I)
Boxes
Regimen for
Previously
treated
patients
(Cat-II)
Boxes
Stock on
first day of
Quarter
Stock received
during the
quarter
Patients
initiated on
treatment
Stock on last
day of Quarter
(a+b) (c)
Quantity
Requested
[(c/3) x 4] (d)
(a)
(b)
(c)
(d)
(e)
Unit of
Measurement
Stock on first
day of Quarter
Stock
received
during the
quarter
Consumption
during the
quarter
Stock on
last day of
Quarter
(a+b) (c)
Quantity
Requested
[(c/3) x 4]
(d)
(a)
(b)
(c)
(d)
(e)
61
Pouches each
with 12 blister
strips
Streptomycin 0.75 g
Vials
Unit of Measurement
Paediatric PC 13
Boxes
Paediatric PC 14
Boxes
Paediatric PC 15
Paediatric PC 16
Stock on
first day of
quarter
Stock
received
during
quarter
Consumption
during
quarter
Stock on last
day of
quarter
(a+b) (c)
Quantity
Requested
[(c/3) x 4]
(d)
(a)
(b)
(c)
(d)
(e)
Unit of
Measurement
INH 300 mg
Tablets
INH 100 mg
Tablets
Rifampicin 150 mg
Capsules
Ethambutol 800
mg
Tablets
Stock on
first day of
quarter
Stock
received
during the
quarter
Consumption
during
quarter
Stock on last
day of Quarter
(a+b) (c)
Quantity
Requested
[(c/3) x 4] (d)
(a)
(b)
(c)
(d)
(e)
Unit of
measurement
IP ( 45 Kg Body wt )
PWB
PWB
CP ( 45 Kg Body wt)
PWB
CP ( > 45 Kg Body
wt)
Na PAS for one
month in 3 boxes (100
gms each)
Stock on
first day
of the Qtr
Stock
received
during the
Qtr
Consumption
during the Qtr
Stock on
last day of
the Qtr
(a+b) c
Quantity
Requested
for TU
(c x 2) d
(a)
(b)
(c)
(d)
(f)
PWB
Carton of 3
boxes
Yes
No
62
Yes
No
Laboratory Consumables*
Item
Unit of
Measurement
Sputum containers
Nos.
Universal containers
for C & DST
Nos.
Slides
Nos.
Litres
Methylene Blue
(0.1% solution)
Litres
Litres
Litres
Immersion Oil/
Liquid paraffin
(Heavy)
mL
Methylated Spirit
Litres
Stock on
first day
of Quarter
Stock received
during Quarter
Consumption
during
Quarter
Stock on last
day of Quarter
Quantity
requested
Equipment in place
Item
Number in place
Binocular microscopes
Two-wheeler
IEC
Number of TB Patient Provider meetings held
Number of Community meetings organized
Signature:
Date:
63
In working condition
District Level
Name of the District:
State:
; Quarter:
Year: ____
NGOs
Community
Volunteers
Public Sector
(including Govt. /
Corporation Medical
Colleges, Govt. health
dept., other Govt. dept.
and PSUs)
Total
Number of TB Units
Number of DMCs
Number of Sputum
collection centres
Number of DOT
Centres/providers
Number of PHIs expected to submit monthly PHI reports
Number of PHIs that submitted monthly PHI reports for all 3 months in the quarter
TU
DMC
Medical
College/ TB
Hospital
PHI (other
than DMC)
DOT
centres
DTO
MO-DTC
DOTS Plus and TB-HIV
Supervisor
3. Referral Activities
a.
Number (%) of PHIs referring >2% of New Adult out patients for sputum examination
4. Microscopy Activities
b.
Number of chest symptomatic patients whose sputum was examined for diagnosis
c.
d.
e.
f.
64
Patients
ICTCs/ART
centers
Of the smear-positive patients diagnosed (f), number put on DOTS within the district
Of the number of smear-positive patients diagnosed (f), number put on RNTCP NonDOTS (ND1 and ND2) within the district
Of the smear-positive patients diagnosed (f), number referred for treatment outside the
district
Initial defaulters j = f (g+h+i)
i.
j.
Number (%) of all smear positive patients started on RNTCP DOTS treatment within 7
days of diagnosis (Information from TU PM report)
7.2. Number (%) of all smear positive patients registered within one month of starting RNTCP
DOTS treatment (Information from TU PM report)
7.3. Number (%) of all cured smear positive patients* having end of treatment follow-up
sputum examination done within one week of last dose (Information from TU PM report)
7.4. Number (%) of patients (all forms of TB) registered during the quarter receiving DOT
through a community volunteer (Information from TU PM report)
* These cases should be from the same quarterly cohort which have been included in the report on Results of Treatment
YES / NO
Number
Sanctioned
State Govt
Staff/staff from
other programmes
65
Contractual
under RNTCP
Total in
place and
Trained
Number
trained/retrained
during reporting
period
11. Medications
Adult Patient Wise Box
Item
Unit of
Measurement
Stock
on first
day of
Quarter
(a)
Regimen
for New
patients
(Cat-1)
Boxes
Regimen
for
Previously
Treated
(Cat-2)
Boxes
Stock
received
during
the
quarter
Stock
transferred
in
(b)
(c)
Reconstitution of
boxes
during
Quarter
Stock
Transferred
Out *
(d)
(e)
66
Patients
started
on
treatment
Stock on
last day
of
Quarter
(a+b+c+d)
(e+f)
(f)
(g)
Quantity
Requested
[(f/3) X 7]g
(h)
Unit of
Measurement
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
(a)
Prolongation
Pouches
Pouches
each with
12 blister
strips
Streptomycin
0.75 g
Vials
Stock
transferred
in
Reconstitution during
quarter
Stock
Transferred
Out *
Consumption
during the
quarter
Stock on
last day
of
Quarter
(a+b+c+d)
(e+f)
(b)
(c)
(d)
(e)
Quantity
Requested
[(f/3) X 7]g
(f)
(g)
(h)
Consumption
during
quarter
Stock on
last day
of
Quarter
Quantity
Requested
Unit of
Measurement
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
(a)
Paediatric
PC 13
Boxes
Paediatric
PC 14
Boxes
Paediatric
PC 15
Pouches
each with
12 blister
strips
Paediatric
PC 16
Pouches
each with
12 blister
strips
Stock
transferred
in
Reconstitution
during the
Quarter
Stock
transferred
Out *
(a+b+c+d)
(e+f)
(b)
(c)
(d)
(e)
(f)
[(f/3) X 7]g
(g)
(h)
Unit of
Measurement
INH 300 mg
Tablets
INH 100 mg
Tablets
Rifampicin
150mg
Capsules
Pyrazinamide
750 mg
Tablets
Ethambutol
800 mg
Tablets
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
Stock
transferred
in
Stock
Transferred
Out *
Consumption
during
Quarter
Stock
on last
day of
Quarter
(a+b+c)
(d+e)
Quantity
Requested
[(e/3) X 7]-f
(a)
(b)
(c)
(d)
(e)
(f)
(g)
*Enclose copy of drug transfer-out form with the printed copy of the report
67
Unit of
measurement
IP ( 45 Kg Body wt )
PWB
PWB
CP ( 45 Kg Body wt)
PWB
CP ( > 45 Kg Body
wt)
Na PAS for one
month in 3 boxes (100
gms each)
Stock on
first day
of the Qtr
Stock
received
during the
Qtr
Consumption
during the Qtr
Stock on
last day of
the Qtr
(a+b) c
Quantity
Requested
for DTC
(c x 2) d
(a)
(b)
(c)
(d)
(e)
PWB
Carton of 3
boxes
Yes
No
** Regimen for new cases -12 months; Regimen for previously treated cases -14 months; PC 13 & PC 14 - 12 months;
MDR treatment regimen -9 months
Have any drugs expired drugs during the quarter?
If yes attach details
Yes
No
Unit of
Measurement
Sputum containers
Nos.
Nos.
Slides
Nos.
Gms
Gms
Litres
Gms
Litres
ml
Methylated Spirit
Litres
Stock on
first day of
Quarter
Stock received
during Quarter
Consumption
during
Quarter
Stock on
last day of
Quarter
Number in place
Source
(RNTCP / Others)
Binocular microscopes
Weighing Balance
Photocopier
Computer
68
14. PPM-DOTS
14.1. Participation of Medical Colleges and TB Hospitals
(a) Nature of ownership
Health facility
Medical
Colleges
TB Hospitals
Government
With
Without
RNTCP
RNTCP
facility
facility
Private
With
Without
RNTCP
RNTCP
facility
facility
With
RNTCP
facility
Total
Without
RNTCP
facility
MO
LT
TBHV
14.2. Number of NGOs/ private practitioners participating in RNTCP during the quarter*:
ACSM
Sputum
collection
Sputum
Transport
DMC
(a)
Slum
TU
NGO
PPs
Total
ESI
Railways
CGHS
Prisons
Corporate hospitals
PSU/others (mining, shipping, defence)
69
TBHIV
Total
No. conducted
Financial Management
Latest month for which all RNTCP contractual staff has been paid remuneration
Latest month for which all RNTCP contractual staff has been paid Vehicle maintenance / POL
Period up to which payments to NGO/PPs under signed schemes have been made
Period up to which payments to eligible Community DOT Providers has been made
Date:
70
Public Sector
(including Govt. /
Corporation Medical
Colleges, Govt.
health dept., other
Govt. dept. and
PSUs)
NGOs
Community
Volunteers
Total
Number of Districts
Number of STDCs
Number of State drug
stores
Number of TB Units
Number of DMCs
Number of RNTCP
accredited culture and
DST labs
Number of DOTS plus
sites
Number of DOT
Centres/providers
Number of Sputum
collection centres
The following reports are enclosed (Tick [] to indicate that report is enclosed)
)
)
(Unit This would generally be the district, however in certain cases the district may have 2 or more separate reporting
units like Municipal Corporation and rural areas. Each reporting unit should be counted for reporting purpose)
*If any unit did not submit reports, list name(s), report(s), reason(s) and action taken ______________________________
_________________________________________________________________________________________________
71
Yes
Yes
No
No
Yes
Yes
No
No
Number of districts for which an internal evaluation was performed in the quarter:
Number of District Internal Evaluation reports sent to CTD in the quarter:
3. Referral Activities
a.
Number (%) of PHIs referring >2% of New Adult out patients for sputum
examination
4. Microscopy Activities
b.
c.
d.
e.
f.
5. Treatment Initiation
g.
Of the smear-positive patients diagnosed (f), number put on DOTS within the
district
h.
i.
72
Activity
Cumulative
number
No. of districts visited by IRL team for the purpose of OSE and
panel testing during the quarter and the year
No. (%) of STLS failing the panel testing
Number (%) of DMCs with High False Results (HFN and/or
HFP results) till the previous quarter and in the year (January
to December):
Number (%) of DMCs with High False Positive (HFP) Results
till the previous quarter and in the year (January to December):
Number of districts who have submitted of EQA annex-E for all
the 3 months of the previous quarter to IRL
4.
5.
Sanctioned
State
Government
Staff/staff
from other
programmes
State TB Cell
STO
Deputy STO
MO State TB Cell
Epidemiologist
TB HIV co-ordinator
Urban TB Coordinator
IEC Officer
Accountant
Data entry operator
Secretarial Assistant
State TB Training and Demonstration Centre
STDC Director
IRL Microbiologist
STDC Medical
Officers
Epidemiologist
73
Contractual
under
RNTCP
Total in
place and
Trained
Number
trained/retrained
during reporting
period
Sanctioned
State
Government
Staff/staff
from other
programmes
74
Contractual
under
RNTCP
Total in
place and
Trained
Number
trained/retrained
during reporting
period
No. of trainees
batch-wise
From (Date)
To (Date)
Duration (Days)
(a)
(b)
(c)
(d)
Total training days
Number in place
State HQ
STDC
All RNTCP
Districts
In working condition
State
HQ
STDC
All RNTCP
Districts
Binocular microscopes
X-ray machine of DTC
Photocopier
Fax machine
Computer
Internet connection
LCD projector
Overhead projector
Vehicles
Jeep / Four-Wheelers
10 seater bus
Two-wheeler
Is there an AMC in place for binocular microscopes?
Yes No
Yes No
Any IRL equipment for culture and DST on solid media not working/not available
Yes No
75
Stock
on first
day of
Quarter
(a)
Stock
received
during
the
quarter
(b)
Stock
transferred
in
(c)
Reconstitution
of boxes
during
Quarter
(d)
Stock
Transferred
Out *
(e)
Patients
started
on
treatment
(f)
Stock on
last day
of
Quarter
(a+b+c+d)
(e+f)
(g)
Quantity
Requested
[(f/3) x 10]g
(h)
Regimen
for New
Patients
(Cat-1)
Regimen
for
Previously
treated0
Patients
(Cat-2)
Stock
Stock
Stock
Reconstitution
Stock
Consumption Stock on
on first received transferred during Quarter Transferred
during
last day of
Out *
day of
during
in
Quarter
Quarter
Quarter
the
(a+b+c+d)
quarter
(e+f)
(a)
(b)
(c)
(d)
(e)
(f)
(g)
Quantity
Requested
[(f/3) x 10]-g
(h)
Prolongation
pouches each
with 12 blister
strips
Streptomycin
0.75 g (vials)
Stock
Stock
Stock
ReconstituStock
Consump- Stock on
Quantity
on first received transferred tion during Transferred
tion
last day
Requested
in
Out *
day of during
Quarter
during
of
Quarter
the
Quarter
Quarter
quarter
(a+b+c+d)
[(f/3) X 10]-g
(e+f)
(a)
(b)
(c)
(d)
Paediatric PC
13 (Boxes)
Paediatric PC
14
(Boxes)
76
(e)
(f)
(g)
(h)
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
Stock
transferred
in
Stock
Transferred
Out *
Consumption
during
Quarter
Stock
on last
day of
Quarter
(a+b+c)
(d+ ef)
(a)
(b)
(c)
(d)
(e)
(f)
Quantity
Requested
[(e/3) X 10]-f
(g)
77
Patient
Wise
Boxes
(From
Compilation
of
District
PMR
Reports)
IP ( 45 Kg Body Weight Patient)
IP ( > 45 Kg Body Weight Patient)
CP ( 45 Kg Body Weight Patient)
CP ( > 45 Kg Body Weight Patient)
NA PAS containing drugs for 1
month in 3 small boxes
SODIUM PARA-AMINOSALICYLIC
ACID (NA PAS)
Item
PWB
PWB
PWB
PWB
Carton
of
3
boxes
Vials
Vials
Caps
Caps
Tabs
Tabs
Tabs
Tabs
Tabs
Tabs
Tabs
Box of
100
gms
UOM
(a)
Stock
on
first day of
the Qtr (SDS
+ DOTS Plus
Site +DTCs)
Stock transferred In /
received during the
Qtr (From Suppliers +
returned
back
incomplete
IP/CP
boxes from DTCs)
(b)
(X)
Transfer
Out
(From
SDS
only)
Note: For filling in information in Column ( c), the loose drugs in the IP/CP boxes as in (X) need to be accounted for purposes of compilation.
1
2
3
4
5
1
2
3
4
5
6
7
8
9
10
11
12
S.No.
(e)
Requirement/
Request
for
transfer
of
drugs
Health facility
Medical Colleges
TB Hospitals
Private
With
Without
RNTCP
RNTCP
facility
facility
With
RNTCP
facility
Total
Without
RNTCP
facility
MO
LT
TBHV
Sputum
collection
Sputum
Transport
DMC
(a)
DMC
(b)
LT
Culture
& DST
Adherence
Slum
TU
TBHIV
Total
NGO
PPs
Total
ESI
Railways
CGHS
Prisons
Corporate hospitals
PSU/others (mining, shipping, defence)
(Attach list of NGOs and private sector institutions, which have started participating in any of the above schemes in the most
recent quarter including name, address, and scheme.)
79
No. Implemented
MM/YYYY
Latest month for which all RNTCP contractual staff at the state level has been paid
remuneration
Latest month for which all RNTCP contractual staff in all districts have been paid their
remuneration
Latest month for which all RNTCP contractual staff in all districts have been paid
Vehicle maintenance / POL
Period up to which payments to NGO/PPs under signed schemes in all districts have
been made
Period up to which payment to the eligible Community DOT Providers has been made
in all the districts
Signature: ____________________________________
Date: _________________________________
80
Table of Contents
Module - 6
Programme Management
Introduction ................................................................................................................................
Learning Objectives .....................................................................................................................
District & State Annual Action plan .............................................................................................
Annual Action plan format ..........................................................................................................
Training .......................................................................................................................................
Training Induction........................................................................................................................
Implementation of training plan .................................................................................................
Activity in ACSM ..........................................................................................................................
Social Mobalization .....................................................................................................................
Developing ACSM Annual action plan .........................................................................................
Engaging all care providers..........................................................................................................
PPM Providers .............................................................................................................................
Eligibility and grants ...................................................................................................................
Role of RNTCP ..............................................................................................................................
Role of NGO .................................................................................................................................
Involvement of Medical colleges in the RNTCP ...........................................................................
Financial management under RNTCP ..........................................................................................
National Rural Health Mission (NRHM) .......................................................................................
83
83
83
84
93
94
97
101
102
105
107
108
109
111
111
118
122
126
MODULE 6
PROGRAMME MANAGEMENT
Introduction
Programme management comprises of planning, implementation and its
maintenance. Realistic planning is based on situational analysis of geographical and
demographic features and the available infrastructure. Implementation consists of provision
of trained staff, ensuring logistics in place and service delivery. The objectives are achieved
and maintained through recruitment and training of the required staff, maintaining logistics
in place, promotion of programme through advocacy and IEC activities and maintenance of
quality of services involving all the stake holders, supervision, monitoring, periodic
evaluation and appropriate corrective actions
Learning objectives: At the end of the module the participants will learn about various
83
This action plan and budget have been approved by the DHS (District health society).
Signature of the DTO __________________________________
Name__________________________________ Designation ______________________
Section-A General Information about the District
1 Population (in lakh) please give projected population 20__
2 Urban population
3 Tribal population
4 Hilly population
5 Any other known groups of special population for specific
interventions
(e.g. nomadic, migrant, industrial workers, urban slums)
(These population statistics may be obtained from Census data / District Statistical Office)
Name of the TU
Population (in
Lakhs)
1
2
3
4
5
6
7
8
9
DISTRICT
84
NGO
No. of MCs
Govt
NGO
Private
TB
Unit
Total
number
of
patients
put on
treatment
No of
new
smear
positive
cases
put on
treatment
Total case
notification
rate (per
lakh pop)
New
smear
positive
case
notification
rate (per
lakh p op)
Proportion of
TB patients
tested for HIV
Cure rate
No. of MDR
cases put on
treatment
Priority areas
DTC
TUs
DMCs
Number
required
as per the
norms in
the district
Number
actually
present in
the district
(a)
(b)
Number
planned
for this
year
Please provide
justification if an increase
is planned (use separate
sheet if required)
Estimated
Expenditure
on the activity
(d)
(e)
(c)
Total
85
Quarter in
which the
planned
activity
expected to
be
completed
(f)
Amount
permissible
as per the
norms in the
district
Amount
actually
spent in
the last 4
quarters
Procurement
planned during
the current
financial year
(in Rupees)
(a)
(b)
(c)
Estimated
Expenditure for the
next financial year
for which plan is
being submitted
(Rs.)
(d)
Justification/ Remarks
for (d)
(e)
Purchase of
Lab Materials
Honorarium
Activity
Amount
permissible
as per the
norms in
the district
(a)
Amount
actually
spent in
the last
4
quarters
(b)
Expenditure
(in Rs)
planned for
current
financial
year
(c)
Estimated Expenditure
for the next financial
year for which plan is
being submitted
(Rs.)
Justification/
Remarks for (d)
(d)
(e)
86
When
Time Frame
Budget
Challenge 1.
Advocacy Activities
Communication Activities
Challenge 2:
Advocacy Activities
Communication Activities
Social Mobilization
Challenge 3:Advocacy activities
Communication activities
87
Item
Office Equipment
(Maintenance includes computer
software and hardware
upgradation,repairs of
photocopier, fax, OHP etc)
Binocular Microscopes (
RNTCP)
Number.
actually
present
in the
district
Amount
actually
spent in
the last
4
quarters
Amount
Proposed for
Maintenance
during
current
financial yr.
(a)
(b)
(c)
Estimated
Expenditure for
the next
financial year
for which plan
is being
submitted
(Rs.)
(d)
Justification/
Remarks for (d)
(e)
Total
Training:
Activity
Training of MOs
Training of LTs of
DMCsGovt + Non Govt
Training of MPWs
Training of MPHS,
pharmacists,
nursing staff, BEO etc
Training of Community
Volunteers (CV)
Training of Private
Practitioners
Other trainings #
Number
in the
district
Number.
already
trained
in
RNTCP
Number planned
to be trained in
RNTCP during
each quarter of
next FY
(c)
Expenditure
(in Rs)
planned for
current
financial
year
(a)
(b)
Q1
(d)
Q2
88
Q3
Q4
Estimated
Expenditure
for the next
financial
year for
which plan
is being
submitted
(Rs.)
(e)
Justification/
remarks
(f)
Vehicle Maintenance:
Type of Vehicle
Four Wheelers
Two Wheelers
Number
permissible
as per the
norms in
the district
Number
actually
present
(a)
(b)
Amount
spent on
POL and
Maintenance
in the
previous 4
quarters
(c)
Expenditure
(in Rs)
planned for
current
financial
year
(d)
Estimated
Expenditure for
the next financial
year for which
plan is being
submitted
(Rs.)
(e)
Justification/
remarks
(f)
Total
Vehicle Hiring:
Hiring of
Four
Wheeler
For DTO
For MO-TC
Number
permissible
as per the
norms in the
district
Number
actually
present
Amount
spent in
the
previous 4
quarters
Expenditure
(in Rs)
planned for
current
financial year
(a)
(b)
(c)
(d)
89
Estimated
Expenditure for
the next
financial year
for which plan
is being
submitted (Rs.)
(e)
Justification/
remarks
(f)
ACSM Scheme: TB
advocacy,
communication, and
social mobilization
SC Scheme: Sputum
Collection Centre/s
Transport Scheme:
Sputum Pick-Up and
Transport Service
DMC Scheme:
Designated Microscopy
Cum Treatment Centre
(A & B)
LT Scheme:
Strengthening RNTCP
diagnostic services
Culture and DST
Scheme: Providing
Quality Assured Culture
and Drug Susceptibility
Testing Services
Adherence scheme:
Promoting treatment
adherence
Slum Scheme: Improving
TB control in Urban
Slums
Tuberculosis Unit Model
TB-HIV Scheme:
Delivering TB-HIV
interventions to high HIV
Risk groups (HRGs)
Number.
of
NGOs
currently
involved
in
RNTCP
in the
district
(a)
Additional
enrolment
planned
for this
year
Amount
spent in
the
previous
4
quarters
Expenditure
(in Rs)
planned for
current
financial
year
Estimated
Expenditure for
the next
financial year
for which plan
is being
submitted
(Rs.)
Justification/
remarks
(b)
(c)
(d)
(e)
(f)
TOTAL
Miscellaneous:
Activity*
Amount
permissibl
e as per
the norms
in the
district
(a)
Amoun
t spent
in the
previo
us 4
quarter
s
(b)
Expenditur
e (in Rs)
planned
for current
financial
year
Estimated Expenditure
for the next financial year
for which plan is being
submitted
(Rs.)
Justification/ remarks
(c)
(d)
(e)
Total
* Please mention the main activities proposed to be met out through this head
90
Medical OfficerDTC
STS
STLS
TBHV
DEO
Accountant
part time
Contractual
Driver
Contractual LT
Senior TBHIVDOTSPLUS
Supervisor
Number.
required as
per the
norms in the
district
Number.
actually
present
in the
district
Number.
planned to
be
additionally
hired during
this year
(a)
(b)
(c)
Amount
spent in
the
previous
4
quarters
Expenditure
(in Rs)
planned for
current
financial
year
(d)
Estimated
Expenditure
for the next
financial
year for
which plan
is being
submitted
(Rs.)
(e)
-
Justification/
remarks
Total
Printing:
Activity
Printing*
Amount
permissible as
per the norms in
the district
(a)
Amount spent
in the previous
4 quarters
(b)
Expenditure (in
Rs) planned for
current financial
year
(c)
Justification/
remarks
(e)
Medical Colleges
Activity
Contractual Staff:
Amount permissible
as per norms
(a)
TOTAL
91
Justification/
remarks
(c)
Number
actually
present in the
district
(a)
4-wheeler **
2-wheeler
Number
planned for
this year
Justification/
remarks
(b)
(c)
(d)
Procurement of Equipment:
Equipment
Office Equipment
(computer, modem,
scanner, printer, UPS
etc)
Any Other
Number
actually present
in the district
Number
planned for
this year
(a)
(b)
Estimated Expenditure
for the next financial
year for which plan is
being submitted (Rs.)
(c)
Justification/ remarks
(d)
S.No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Category of Expenditure
Civil works
Laboratory materials
Honorarium
ACSM
Equipment maintenance
Training
Vehicle maintenance
Vehicle hiring
NGO/PP support
Miscellaneous
Contractual services
Printing
Research and studies
Medical Colleges
Procurement vehicles
Procurement equipment
TOTAL
DTO must ensure that District Health Society reviewed the action plan and approved. In
addition to assisting in logical planning, this would also save time as the member secretary
will not have to seek approval for each individual activity.
District Annual Action Plans are then compiled at the state level and the State Annual
Action Plan is prepared including budget for state level activities, incorporated in the NRHM
State Annual Action plan and submitted. A copy of the State annual action plan is also sent
to Central TB Division. CTD releases lump-sum amount twice a year to the State Health
Society (RNTCP sub-account) for onward distribution to District Health Society (RNTCP
92
2. Training
An adequate number of trained manpower is critical to the successful implementation of
RNTCP. High quality training has to be imparted at different levels periodically to take care
of promotions, transfers and superannuation through induction training, retraining and
periodic updating.
It is imperative to conduct quality training of all levels of personnel who have TB-related
responsibilities. It is ensured by careful planning that, all types of key personnel who
perform TB-related activities are adequately trained while assuming responsibility of
implementation of RNTCP or any new initiatives under the programme. The entire training
process should be closely monitored by the State / District officials.
Development of training schedule
Since the personnel at each level support and supervise the level directly below them,
generally staff at the state level should be trained prior to the staff at the district level, and
the staff at the district level should be trained prior to the staff at the sub-district and
peripheral levels. To help ensure that the appropriate persons are trained at the correct
time, a training schedule is developed for the staff of the health services and the staff of the
laboratory services separately.
Following factors are considered while developing the training schedule
Services of the staff from well performing neighboring districts / states can be availed for
training purposes. Well performing districts should be utilized as field demonstration areas
during training whenever possible. All classroom teaching should be demonstrated at these
field sites.
Induction training: Initial training before assuming the responsibilities of the programme
Update training: Newer initiatives or changes in the policy of the programme are to be
conveyed to the health personnel
Re-training / refresher training: Based on training needs of the identified personnel
focused on specific deficits of knowledge or skills
93
Duration
(working
days)
12
Batch
size
12
Training Material
Central Institute
20
20
District
12
STS (2+6)
12
STLS (10+5)
LT
State Drug Store Staff
/Pharmacist in RNTCP
15
10
3
6
8
25
MPHS
25
2
2
1
25
25
25
6 hrs
20
DTC/IMA
6
6
12
Need
based
12
STS Module
Handbook of communication
strategy
MPW module, then Epicentre
training
STDC/District
Central level
Need
based
Need
based
Manual on Financial
Management and Guidelines
Manual on Financial
Management and Guidelines,
DTCS/ STCS guidelines
2+2
20
Venue
STDC
STDC
STDC
District
District/TU
District/TU
TU/PHI
TU/PHI
TU/PHI
Duration
(days)
5
Batch
Size
10
Training Material
EQA Manual
Central Institute
EQA Manual
Central Institute
15
EQA Manual
Central Institute
94
Venue
Duration
(days)
2
1
Batch
Size
10
10
1/2
1
1/2
30
10
30
Training Material
Venue
TB-HIV Modules
Module for MOs on TB/HIV
State level
State level
District
District
TU/PHI
Duration
(days)
2
1
Batch
Size
10
10
1/2
1
30
10
30
Training Material
Venue
TB HIV Modules
Module for MOs on TB/HIV
State level
State level
District
District
TU/PHI
Type of training
Place of
training
Trainers
Training material
Duration
(in days)
Concise modular
National
institute
State-level
Central institute
staff
STC/STDC staff
RNTCP Key
facts and concepts
1-9 modules
1*
6
National/
State-level
State-level
Central Institute/
STC/STDC staff
STC/STDC staff
1-9 modules
12
1
MO modules
Medical
college
Faculty in charge
of RNTCP
RNTCP Key
facts and concepts
1-3 modules
Part of Curriculum
+ Sensitization
Medical
College
Faculty in charge
of RNTCP
Curriculum
2-3 hrs**
MO-TC modular
MO-TC modular
Concise modular
MPW training
Medical
College
Faculty in charge
of RNTCP
MPW module
Pharmacists
MPW training
Medical
College
Faculty in charge
of RNTCP
MPW module
Other paramedical
staff
MPW training
Medical
College
Faculty in charge
of RNTCP
MPW module
5 days or 12 days modular training for those interested. **Consists of theory classes. Practical training will be imparted during
posting to the Chest or Medicine Departments and the DOTS Cell.
Training and retraining should be planned and undertaken periodically based on training needs
assessment.
95
Promising facilitators for future trainings can be identified during the training of state
and district level staff. Personnel from the general health services, general laboratory
services, and experts in TB from other institutions in the country (e.g. medical or nursing
schools) may all be good candidates for being facilitators.
Facilitators training: During facilitator training, each prospective facilitator should
complete the module(s) they will facilitate. They should read all the training material and
complete all the exercises (e.g. role plays, individual exercises). During the training course,
trainees are encouraged to think about areas which they may find difficult and plan ways to
help make it easier. They are also facilitated to identify ways to answer potential questions
and concerns. Initially these personnel can participate as co-facilitators in a training course
with an experienced facilitator before they start to facilitate independently.
EXERCISE 1
For this exercise, you will work with a colleague to discuss potential problems in planning
course logistics and obtaining resources for training.
Instructions
1. Discuss potential problems in planning course requirements and obtaining resources
for the course. Record your responses on the table below.
2. Identify ways to reduce or eliminate the problems.
Potential problems
Possible causes
Possible solutions
Planning of training should be a part of annual action plan at state and district level
which should include the tentative time schedule for the year decided in consultation
with respective authorities well in advance. The training plans are implemented after the
receipt of the required funds. This will include training the state / district personnel as
mentioned above.
97
Maximum duration
(days)
5
3
2
3
2
2
1
Venue
Central Institute
STDC
STDC
STDC
District
District
District/TU
1
1
1
1
District/TU
TU/PHI
TU/PHI
TU/PHI
1
1
2
2
1
1
1
1
1
1
2
1
TU/PHI
State/District
Central Institute
Central Institute
Central Institute
STDC
District
STDC
District
District
State
District
It is imperative to ensure that the highest quality of training is undertaken by RNTCP. This
is the first step towards achieving technical excellence and success of the programme.
Policy advocacy informs senior politicians and administrators how an issue will affect
the country, and actions taken to improve laws and policies e.g. TB medicines to be
made available to everyone free of cost.
Programme advocacy targets opinion leaders at the community level on the need for
local action e.g. Panchayat decided to spend a particular amount of time during each
gram sabha meeting to talk about going for sputum examination if there is 2 weeks or
more cough.
Media advocacy validates the relevance of a subject, puts issues on the public agenda,
and encourage the media to cover TB-related topics regularly and in a responsible
manner so as to raise awareness of possible solutions and problems e.g. sensitive
reporting to combat stigma and discrimination.
Activities for Advocacy
Conducting seminars on TB prevention and control for local officials and community
organizations. To share views and experiences, leading to a better understanding of the
challenges that the program is facing.
Distributing letters and fact sheets to local authorities at all levels and local
organizations to gain support for TB related activities.
Working with journalists and reporters to ensure accurate reporting of TB related issues
and stories.
Organizing meetings and parades each year on World Tuberculosis Day (March 24) at
the district level. Local officials, stakeholders, and community leaders should be
encouraged to participate in these events.
101
Mass Media This is use of radio, television and print media since they have a wide
reach to the population. It is a powerful tool for raising awareness, building knowledge
and indicating public opinion.
Outdoor advertizing It can enhance the campaign effectivity, recall and longevity as it
is accessible to a large number of people in rural and urban areas.
Information, Education and Communication material This is not only a tool in itself, but
also serves as a direct support for trainings, advocacy and social mobilization activities.
Materials that can be used range from brochures & booklets, pamphlets, flyers &
stickers, posters, calendars, flip charts, flash cards to street plays, songs, mobile
phones, exhibitions, folk media and community radio. There may be range of other
innovative approaches.
Social Mobilization
Social mobilization is a community based approach. The key to success of controlling TB is
to build the momentum for change at the district and community level. A range of different
social mobilization tools can be used, including traditional community theatre, folk media,
art and other performance festivals. These communication forms make use of idiomatic
expressions, which vary from one ethnic community to another and are the basis for
communication within and across generation and community leadership structures.
Activities for social mobilization
Theatre, Melas, Folk shows, Cultural events this is one of the most cost effective
and useful way of community mobilization.
Health stalls and kiosks this is a great way to create awareness and increase
knowledge about TB at grass root level.
Mobile cinemas, Puppet shows this strategy when combined with a range of other
community activities and service delivery can be effective in supporting the behavior
change process.
103
Key messages and media options for different target groups (Example)
Target
group
Patient
and their
families
General
Public
Health
Care
Providers
(Public
and
private)
Decision
makers/
opinion
leaders
Objectives
Key messages
Media options
Community level
meetings eg., Mahila
Mandals, Panchayat
meetings, youth clubs.
Outdoor publicity
Out reach activities
(Street plays, folk
media, street
theatre, haats,
melas and
festivals)
Mass media
(electronic media)
Sensitization
meetings
CMEs/Seminars
News
paper/journals
Information
booklets
Electronic media
104
Inter-personal
communication
Patient provider
interaction
meetings
Outdoor publicity
(Hoardings, wall
paintings, posters,
bus panels,
banners etc.)
One to one
meetings
World TB Day
activities
News papers/print
media/ Brochures
Electronic media
Step 4- Assess whether you can improve the situation using ACSM
Step 5- Developing ACSM action plan
Annual Action Plan Format for Advocacy, Communication and Social Mobilization
(ACSM) for RNTCP
1) Information on previous years Annual Action Plan
a) Budget proposed in last Annual Action Plan: .
b) Amount released by the state: ..
c) Amount Spent by the district-
2) Permissible budget as per norm
3) Budget for next financial year for the district as per action plan detailed below: .
105
(Maximum 3
Challenges )
WHY
ACSM
Objective
Desired
behavior or
action
(make
SMART:
specific,
measurable,
achievable,
realistic &
time bound
objectives)
For
WHOM
Target
Audience
WHAT
When
ACSM Activities
Time Frame
Activities
Media/
Material
Required
Q1
Q2
Q3
By WHOM
Q4
Key
implementer
and RNTCP
officer
responsible
for
supervision
Monitoring and
Evaluation
Outputs;
Outcomes:
Evidence
that the
activities
have
been
done
Evidence
that it has
been
effective
Challenge 1.
Advocacy Activities
Communication Activities
Challenge 2:
Advocacy Activities
Communication Activities
Social Mobilization
Challenge 3:Advocacy activities
Communication activities
106
Budget
Total
expenditure
for the
activity
during the
financial
year
PPM providers
PPM is an integral part of RNTCP and the programme encourages involvement of all care
providers throughout the country to meet the objectives of the programme. However
disaggregated data on types of care providers is not captured throughout the country.
For the surveillance purpose RNTCP has identified 14 PPM sites in the country and
disaggregated data is being collected on quarterly basis classifying the care providers in
five types as below:
Private Providers
They can be from
Private Hospitals & Nursing Homes, Private Practitioners (PPs) practicing allopathy
and allopathic Chemist Shops
Other Systems of Medicine
Traditional healers
The NGOs are expected to coordinate with District RNTCP units to implement a minimum
set of advocacy, communication, and social mobilization interventions in a district, either by
themselves or with partners. Implementing partners can include Panchayat Raj Institutions
(PRI), Self-Help Groups (SHG), Faith-Based Organizations (FBOs), Community-based
organizations (CBOs), Rotary Club chapters, other NGOs, etc. The activities should reach
an area with a minimum of 5, 00,000 (0.5million) population, but preferably should cover 10,
00,000 (1million) population or greater.
Eligibility and grants
Registered NGOs with capacity and commitment with at least 2 years experience in social
mobilization activities and grass root level activities are eligible. Local presence and
familiarity with local culture will be desirable.
An amount of Rs 1,50,000 per 1 million population per year ( pro-rata for population
covered) is available under this scheme.
The role of the DTO/STO will include joint planning with the NGO for identification of issues
that need to be addressed to strengthen ACSM component. DHS will help the NGO in
identification of pockets within the district which needs attention for awareness generation,
social mobilization and community empowerment
109
110
Culture and DST Scheme: Providing Quality Assured Culture and Drug
Susceptibility Testing Services
The programme is in the process of establishing a nation-wide network of quality assured
sputum / specimen culture and drug susceptibility testing (C&DST) laboratories for the
diagnosis and follow-up of multi-drug resistant TB (MDR-TB) patients in the nongovernment sector.
Eligibility: An existing well-functioning mycobacterium culture and DST laboratory in the
private/NGO sector can apply under this scheme. The applicant laboratory should have
adequate infrastructure, equipment and staff to undertake the sputum culture & DST
activities. The sputum culture and DST services are to be free of charge to all patients
referred by the programme.
Grant-in -aid : The initial payment by RNTCP will be based on a pre-decided number of
MDR suspects as per RNTCP DOTS-Plus implementation plans. The fee payable for
sputum / smear, culture, species identification and drug susceptibility testing for at least the
4 first line anti-TB drugs, namely Rifampicin, Isoniazid , Ethambutol, and Streptomycin, will
be Rs.2,000/- per specimen, and for undertaking smear, culture and species identification
will be Rs.400/- per specimen.
Responsibilities of the NGO/Private Facility: Establishment and maintenance of this
facility will be as per NTCP guidelines.
113
Grant-in-aid
For NGOs supervising DOT services:
Administrative and additional treatment support functions: Rs 40,000 for every 1 lakh
population per annum, on pro-rata basis for population served.
For DOT:
For patients put first line regimen: Rs250 to the individual volunteer for each patient
cured or treatment completed
For MDR-TB patients put on DOTS PLUS regimen : Rs 2500/- (Rs 1000/- for IP and Rs
1500/- for CP) to the individual volunteer for each patient treatment completed, to be
disbursed in two installments.
Grant-in-aid (PPs):
PPs providing DOT
Rs 400/- per patient successfully treated with all services (i) (v) listed above for PPs,
i.e. treatment including initial home visit and default retrieval
Rs 250/- per patient successfully treated [If services in item (i) & (v) are not
undertaken] The NGO will be reimbursed at the rate of Rs 150/- per patient for
cured/treatment completed, for undertaking services (i) & (v). If these are activities are
undertaken by the General Health Staff, no honorarium will be paid.
For MDR-TB patients, Rs.2,500/- per patient successfully treated with all the services (i)
to (v) listed above [Rs 1000 after completion of IP and Rs 1500 after completion of CP].
Grant-in-aid:
Rs.50,000 per 20,000 population per annum is available under the scheme.
115
NGOs running a NACP accredited/funded Community Care Centre for HIV, with at least
20 beds.
NGO should already be providing HIV care, including clinical care to the above
described High risk populations and undertaking outreach activities in these populations
NGOs being offered the RNTCP scheme should be willing to undertake delivery of
comprehensive TB care i.e., all components as described below in the TB-HIV Scheme.
116
Grant-in-aid:
An amount of Rs 1,20,000 per NGO per 1,000 Target population is available under this
scheme.
5.
Medical colleges play an important role in supporting any health programme in India.
Medical college faculty have an important role in TB control as opinion leaders and
trendsetters, teachers, imparting knowledge, skills and as partners in sustaining the
programme by teaching and practicing DOTS and as role models for practicing physicians.
Recognizing the signi cant role medical colleges can play, the RNTCP envisaged activities
pertaining to training and teaching, service delivery, advocacy and operational research as
priority areas for collaboration with the medical colleges.
A National Task Force (NTF) and five Zonal Task Forces (ZTF) have been formed for their
effective involvement in RNTCP. Within each zone, nominated medical colleges have been
given the responsibility to function as nodal centers. All states which have medical colleges
have formed State Task Forces (STF). In each medical college, there should be a core
committee to arrange for training and oversee the functioning of the microscopy / treatment
118
These nodal centres are actively involved in the Zonal Task Forces and in the National
Task Force.
Workshops for Task Force
By holding annual workshops at the zonal and national level, RNTCP provides a platform
for the Medical college faculty for sharing experiences and for streamlining the bottlenecks
identi ed in effective collaboration.
National Task Force (NTF)
Composition: Chairman: DDG (TB)
Member Secretary: one from the nodal medical colleges on rotation basis.
Members: One each from CTD, 7 nodal medical colleges, TRC, NTI, LRS and WHO.
The main task of NTF is to provide leadership and advocacy, coordination, monitoring, and
policy development on issues related to effective involvement of medical colleges in
RNTCP.
Zonal Task Force (ZTF)
Composition: Chairman: Representative from the nodal centre (where more than 1 nodal
centre, on rotation basis after 2 years). The list of nodal centres is on page 198.
Member Secretary: STO of the State where nodal centre is located
119
Nodal centres
East
West
North
South
North
East
Gujarat, Rajasthan,
Uttar Pradesh, Delhi, Jammu &
Kashmir, Uttaranchal
Punjab, Chandigarh, Haryana,
Himachal Pradesh
Andhra Pradesh, Karnataka, Kerala,
Pondicherry, Tamil Nadu,
Manipur, Nagaland, Mizoram,
Sikkim, Arunachal Pradesh, Assam,
Tripura, Meghalaya
Functions
1. Societies have been formed to give autonomy in financial matters and to provide greater
discretion, enhanced responsibility, and more ownership to the states. Societies
undertake activities through bottom-up approach in planning and budgeting process,
i.e. from DHS (TB)-SHS (TB)-CTD and flow and release of funds from top down
approach from CTD-SHS-STDC/DHS.
122
Functions
The main objective of the District Health Societies (DHS) is to implement the RNTCP
functionally, administratively as well as financially. The government has established the
DHS for the following reasons:
1. Decentralized implementation of the programme
2. Improving co-ordination between the government functionaries and non-government
organizations at the grass root level
3. Timely preparation of audit reports
4. Reducing bottlenecks for smooth flow of funds
The financial activities of the DHS cover the following areas:
1. Obtaining funds, and materials from the State Governments / Societies
2. Ensuring that the funds, equipment and materials are recorded properly in the books of
accounts as per statutory and generally accepted norms and that the same are being
utilized appropriately.
3. Reporting to the Central and State Governments on financial performance according to
the guidelines specified by the Government of India.
(C) Maintenance of Funds of the SHS/DHS
1. A separate saving bank sub-account has to be opened and maintained in any scheduled
banks for RNTCP sub-committee.
2. All funds credited to the society shall be deposited in the bank.
3. Withdrawal from funds including all payments shall be made through crossed cheques/
bank drafts.
4. All cheque shall be signed by any two of the three authorized signatories.
5. Unspent balance after closure of the financial year may be carried forward to the next
financial year.
(D) Mechanism of flow of funds
1. The Government of India (GoI) will make allocation of funds to the SHS on the basis of
plan of action/ budget of the SHS and DHS.
2. The SHS should prepare and submit budget to the CTD by 31st October for the next
financial year.
3. On submission of SOEs (DHS and SHS) by the SHS in April/October, the first and
second release will be made in May/November by the GoI.
4. SHS allocates and releases funds to DHS depending upon their individual performance
and requirement on quarterly/six-monthly basis
5. Timely reallocation of funds as per financial guidelines.
(E) Basic Fundamentals for Preparation of Budget
1. Standard norms and guidelines prescribed by CTD should be strictly adhered to.
123
125
The National Rural Health Mission is a mechanism which has provided an umbrella in all
states with the repositioning of Reproductive and Child Health (RCH) and National Disease
Control Programmes in integrated State/District Health Societies.
TB related objective of the Mission is Prevention and control of communicable and
non-communicable diseases, including locally endemic diseases with expected
outcome of maintaining 85% cure rate through entire Mission period and also sustain
planned case detection rate .
127
128
II.
State Level:
A. State Coordination Committees
To ensure smooth implementation and regular review of TB-HIV Collaborative
activities, State Coordination committees (SCC) chaired by Principal Health
Secretary and with representations of state programme managers of both
programmes are established at the State level. These coordination committees meet
at-least once in 6 months, preferably once in a quarter. The detailed composition and
proposed TOR of State Coordination Committees is described in the National
Framework for Joint TB/HIV collaborative activities October 2009 may be accessed
from website. The SCC can be used to obtain administrative approvals for the TBHIV activities guided by the STWG recommendations. Minutes of quarterly State
129
District level
A. District Coordination Committees
To ensure smooth implementation and regular review of TB-HIV Collaborative
activities, Coordination committees are established at the District level. These
coordination committees are to meet on a quarterly basis. The composition and
proposed TOR of District Coordination Committees is described in the National
Framework for Joint TB/HIV collaborative activities October 2009 and may be
accessed from website. These meetings are to be organized by District Nodal
officers (DNO) for HIV/AIDS or DTOs where DNOs are not available. Minutes of
district quarterly meetings should be sent to SACS and State TB Cell. Whenever
possible, the meetings should be attended by a representative from the STC/SACS
so as to streamline the discussions for the HIV-TB linkages and to raise the district
specific issues.
B.
A monthly meeting of the DTO and the District Nodal Officer (DNO) should be held
with the participation of key staff from both the programmes. Monthly meetings of the
key staff of RNTCP are to be conducted at the district level. It is envisaged that
during these monthly key staff meetings, additional session be organised for TB-HIV
which should be attended by the key district staff of NACP. In these monthly
meetings a review of the on-going TB-HIV collaborative activities and discussion on
key issues emerging from the field should be undertaken. Based on the discussions,
feedback should be sent to the service delivery centres on their performance and on
any identified issues. Follow-up action taken should be monitored and minutes of the
meetings forwarded to SACS and STC.
IV.
130
The expansion of the Intensified TB-HIV package to additional States would be undertaken
in a phased manner, jointly determined by the National Programmes. A tool for assessment
for preparedness for rolling out the Intensified TB-HIV package is provided in the National
Framework for Joint TB/HIV collaborative activities October 2009 and may be accessed
from website. The SACS & STC need to jointly provide information on the tool which would
131
CPT has been shown to reduce mortality among HIV-infected TB patients, and is
recommended by NACP for all HIV-infected patients.
All HIV-infected TB patients should therefore be provided CPT. At a minimum, monthly
provision of CPT should be available at all ART centres for the benefit of those patients who
are able to return to the ART centre on a monthly basis.
In States implementing Intensified TB/HIV package, CPT should also be made available for
HIV-infected TB patients at all PHIs in the districts having a Medical officer and an
institutional DOT centre, using RNTCP mechanisms. The delivery of CPT to all HIV infected
patients after completion of DOTS will be made from ART Centre. The CPT should be
procured and packed into monthly pouches by SACS and the local distribution should be
carried out by RNTCP in coordination with NACP. In this mechanism, CPT is delivered by
the PHI staff, and not community DOT providers, to maintain confidentiality regarding HIV
status within the health-care system.
Guidelines for Operationalization of ICTC-RNTCP Linkages
Service linkages between ICTC and RNTCP diagnostic and treatment centres are the most
important area of co-ordination between the HIV/AIDS and TB Control programme. RNTCP
visualizes ICTC as a PHI referring TB suspects irrespective of their HIV-status. ICTCs will
identify and refer suspected TB cases to the RNTCP Designated Microscopy Centres
(DMCs). DMCs/ OPD/ wards may refer TB patients for counselling and diagnosis of HIV
infection. They could also refer known HIV positive TB patients to the ICTC for
Counselling.
A. Steps for Operationalization
Ensure that the ICTC, DMC and DOT centre are in the same campus. In case they
are not in the same campus, establish referral linkages between them
Ensure that all the ICTC and RNTCP staff, including the LT of the DMCs and ICTC,
are trained in TB/HIV
Provide RNTCP Laboratory Forms for sputum examination/sputum cups, for referral
of patients from ICTC to DMCs under RNTCP
Provide a DMC and DOT centres directory to all the ICTCs
Ensure display of posters on TB at the ICTCs and provide other related IEC material
on TB that is available for distribution to clients
It is ensured that shared confidentiality of HIV status is maintained between the
treating physician and the patient. HIV status is mentioned in the original treatment
card and in the TB registered.
The ICTC Counselors are to visit the DMCs, and the STSs are to visit the ICTCs to
follow-up referred cases.
Monthly RNTCP Review meetings are to be attended by the ICTC staff.
State TB Officer, State ICTC Programme Officer, District TB Officer and District
Nodal Officers (HIV/AIDS) are to review TB/HIV co-ordination activities during their
periodic field visits.
133
Sr. No.
PID No.
Complete Name
and Complete
Address
4
5
Age
Sex
Date of Referral
Name of
RNTCP Unit
referred to
COLUMN TITLE
Is patient
diagnosed as TB
Yes or No
If diagnosed as TB,
specify whether
patient is sputumpositive TB,
sputum-negative
TB or Extra
pulmonary TB
Is patient initiated
on DOTS Yes/No
10
136
Date of Starting
Treatment
12
TB No.
13
Remarks
137
b) of the referred
TB suspects, No.
diagnosed
as
having:
(i) Sputum-positive
TB
(ii)
Sputumnegative TB
(iii)
ExtraPulmonary TB
c) Out of above
(b), diagnosed TB
patients, number
receiving DOTS
138
ICTC Counsellor takes the signature of I/C ICTC on 1st/2nd of the month.
Counsellor takes the I/C ICTCs signature on the monthly report by the 5th/6th
Process of Sending Monthly Report of the month
At District Level: The report will be sent by the ICTC to the District Nodal Officer for
HIV/AIDS, District TB Officer and the State AIDS Control Society. A copy the TB/HIV report
along with the line-list is given to the concerned District Tuberculosis Officer/City TB Officer.
The District Nodal Officer for HIV/AIDS compiles the reports of all ICTC in the district
reports monthly to SACS. The report should reach State AIDS Control Society by 10th of the
month.
At State Level: At the state level, at the SACS the information on TB/HIV activities will be
compiled and a centre-wise report along with the monthly report for the entire state will be
sent to NACO and CTD by the 15th of every month. A copy of this report will also be sent by
SACS to the State TB Office.
139
The ART MO would directly refer the TB suspect to the DMC for sputum microscopy.
This would prevent unnecessary delay in diagnosis of TB and would minimize the
exposure of the HIV patient to other nosocomial infections.
The Lab. Technician would be instructed to collect the sputum sample of the patient
referred from the ART center on priority. The lab technician would be instructed to
mention ART center as the source of referral for such patients in the RNTCP lab
register. These measures would reduce the time spent by the HIV patient in the DMC.
The Lab technician would send the result of the sputum examination of the HIV positive
patient directly to the ART MO for diagnosis and allocation of treatment regimen.
The details regarding operationalization of ICF at ART Centres along with the line-list
and monthly report to be submitted is described in the TB/HIV module for ART centre
staff and may be accessed from www.tbcindia.org
ii.
Process at ICTC
Once the referred TB patient reaches ICTC, the same procedure will be followed as
that for any other client attending ICTC. Some TB patients may come on their own
for HIV Testing (Direct Walk-In).
At the ICTC, the patient/client will undergo pre-test counselling. HIV testing is done
after obtaining informed consent. The details of the patient/client will be entered into
the PID register and Counselling Register. HIV testing is done and the test results
are handed over by the Laboratory Technician to the Counsellor. The counsellor
reveals the HIV test result to the patient/client with post-test counselling. The HIV
test results are not revealed to any other person other than the individual himself.
However, in states implementing Intensified TB/HIV Package HIV test results may be
shared with the treating Doctor.
140
Symptoms of Pulmonary
TB - Cough for more than
two weeks
No symptoms of
TB
Symptoms of Extrapulmonary
TB e.g. cervical
lymphadenopathy, etc.
Feedback
from STS
Fill in RNTCP
Lab form
DMC for Sputum
examination
Medical Officer
Appropriate
Investigation
Sputum
Results
DOT Centre
141
Clients go
back to
ICTC
PID
NO.
Sign of Counsellor
Date of completion:
Sr.No.
Sex
7
Name
of
facility
referred
to
6
Date of
referral
to
RNTCP
YEAR
Age
NAME OF DISTRICT:
REPORTING MONTH:
Date of
Starting
Treatment
11
TB
No.
12
Remarks
13
Signature of DTO/CTO/MO-TU
NAME OF ICTC:
YEAR __________________
NAME OF ICTC:_____________________
DISTRICT:_______________
HIV
Negative
143
Name of NGO/PP
Date of MoU
Name of District
Name of Scheme
Period of MoU
...............to.............
Cheque dated
Cheque number
Amount (Rs.)
......to........
......to........
B. EXPENDITURE
Approved Budget as per MoU
Rs.
Total Grant
Received till this
Quarter
Rs.
a
144
Cumulative
Expenditure till
this Quarter
Rs.
b
Unspent
Balance
Rs.
c=a-b
Name of DTO/STO:
UC Received and Verified:
Signature of DTO/STO:
Date:
by Accountant
Checked UC :
Yes/ No
Yes/ No
Yes/ No
Signature:
Date:
145
Cheque
number
Cumulative Exp. as
per UC
Rs.
Voucher
No.
Quarter 1 (to )
Date
Date UC Received
Rs.
a
Grantin-Aid
as per
MOU
Cumulative Exp. as
per UC
Rs.
Date UC
Received
Amount
Rs.
Cumulative Exp. as
per UC
Rs.
Quarter 3 (to )
Date
Cheque
number
Rs.
f= a - e
Unspent
Balance
d= b +c
Total
Released
Rs.
If
advance,
whether
entered
in
Advance
Register
(Yes/No)
Cumulative
Exp. as per UC
Rs.
Quarter 4 (to )
Date UC
Received
Advance/Reimbursement
Voucher
No.
UC SUBMITTED BY NGO/PP
Quarter 2 (to )
Advance/Reimbursement
Date UC
Received
Amount
Rs.
If
advance,
whether
entered
in
Advance
Register
(Yes/No)
RELEASES TO NGO/PP
Amount
Cheque
number
Rs.
Date
Voucher
No.
Advance/
Reimbursement
Rs.
Grantin-Aid
as per
MOU
Releases to NGO/PP
MOU dated
Period of Scheme
Name of Scheme
Name of NGO/PP
(Yes/No)
If advance,
whether
entered in
Advance
Register
Date
Voucher
No.
Cheque
number
Rs.
Amount
Advance/
Reimbursement
Annexure - 1C
Format for NGO/PP Payment and UC Monitoring Register
(Yes/No)
If advance,
whether
entered in
Advance
Register
d= b +c
Rs.
Total
Released
TU SCHEME
UC SUBMITTED BY NGO/PP
Quarter 1 (to )
Quarter 2 (to )
Quarter 3 (to )
Quarter 4 (to )
Date UC
Received
Date UC
Received
Date UC
Received
Date UC
Received
Cumulative
Exp. as
per UC
Rs.
Cumulative
Exp. as per
UC
Rs.
Cumulative
Exp. as per
UC
Rs.
148
Cumulative
Exp. as per
UC
Unspent
Balance
Rs.
Rs.
f= a - e
B. General:
1) The states will circulate this note on TB-II procurement procedure to all concerned
officials in the health directorate, state and district societies and any other agency
involved in procurement using TB-II fund.
2) The books/records/contracts etc. pertaining to TB-II funding will be kept separately.
As per the agreement with the Government of India, the World Bank will conduct a
procurement audit of a sample of the procurement undertaken under the RCH II
Program every quarter. Records should therefore be maintained in a systematic
fashion so it is easy to select a representative sample of procurement transactions
to be reviewed from the records. Likewise the MoHFW will also conduct annual
procurement audits.
3) The TB-II procurement guidelines are applicable to procurement of goods, works as
well as services (such as training/workshops), IEC activities (printing or distributing
material through an agency), research and studies, hiring of consultants, NGO
services, PPP agreements and other similar contracting).
4) The states will compile the list of contracts issued from TB-II funding at state and
district level and forward this list to the Central TB Division (CTD), MoHFW within 15
days of closing of every quarter in the following format:
Contract/ P.O. Method of
Procurement
Description
Category
(Goods/
Value (Rs.)
Works/Services)
Issued to
(name of
contractor/
supplier)
Date of
Issue (of
new
Contract)
5) As per the agreed procurement procedure, the state and district will not procure
drugs, pharmaceuticals and medical supplies from TB-II funding. However, these
could be procured from the other sources such as NRHM or state government.
6) As per the agreed procurement procedure, the state and district will not procure any
goods, works or service contract exceeding US$ 50,000/- equivalent or less per
contract from TB-II funding (now revised to US$ 30,000/- equivalent or less per
149
For tasks that represent a natural continuation of previous work carried out by the
firm.
Where a rapid selection is essential (emergency operation).
For small assignments; or
When only one firm is qualified or has experience of exceptional worth for the
assignment.
151
Establish the need for the assignment and outsourcing the services
Preparation of the Terms of Reference (TOR)/Scope of Work/Job Description
Preparation of cost estimate and the budget
Preparation of the shortlist of consultants
Preparation and issue of Request for Proposal (RFP)
o Letter of Invitation (LOI)
o Information to Consultants (ITC)
o Proposed contract
Receipt of proposals
Opening and Evaluation of technical proposals
Evaluation of financial proposal
Combined evaluation of quality and cost
Award of the contract to the selected firm
Establish the need for the assignment and outsourcing the services
Preparation of the Terms of Reference (TOR)/Scope of Work/Job Description
Preparation of cost estimate and the budget
Preparation of the shortlist of consultants
152
153
Table of Contents
Module 7
Programme Logistics Management Including Preventive Maintenance
Learning Objectives ...............................................................................................................
Drugs for TB Treatment ........................................................................................................
Effective Drug supply and Management system ...................................................................
Guideline for proper storage of Anti TB drugs .....................................................................
Stock Register Format ...........................................................................................................
Exercise on district level worksheet for reporting drug requirement ..................................
Annexure I to X .....................................................................................................................
157
157
158
160
163
171
188-197
Module 7
Logistics Management Including Preventive Maintenance
Learning objectives
In this module participants will learn the roles and responsibilities of program manager at
each level in logistics and maintenance as mentioned below:
(I)
(II)
(III)
Introduction
Prompt procurement and maintenance of uninterrupted logistics is one of the important
prerequisite for the successful implementation of the Programme. Procurement, storage,
maintenance of reserve stock and distribution of anti-TB drugs and other materials are
essential for quality services under Revised National TB Control Programme. One of the
most important tasks is to make sure that all health facilities have the drugs and materials.
(I)
CTD
Consignee list
Procurement Agency
Release orders
Supply Order
Manufacturer
SDS
GMSDs
Exceptions
Districts
Distribution Cycle
159
160
Date of
Receipt
Date of
Mfg.
Date of
Expiry
Qty.
Received
(Nos.)
AB
10.11.2008
Nov-07
Oct-10
60
CD
15.11.2008
Dec-07
Nov-10
50
EF
25.11.2008
Jan-08
Dec-11
10
161
Name of
Party
(Supplier)
GMSD
Karnal
GMSD
Mumbai
SDS Delhi
Invoice No./
Receipt
Voucher No.
Date of
Invoice/
Voucher
No.
IV 35
1.11.2008
IV 14
8.11.2008
DTA 68
12.11.2008
Quantity Issued
(Nos.)
30
40
40
Sent/Issued to
DTC - A
DTC - B
DTC - C
SIV No. 1
SIV No. 2
SIV No. 3
Date of Issue
Voucher
17.11.2008
26.11.2008
29.11.2008
Please record the above transactions in the Stock Register format provided on the page overleaf.
162
10
(c)
Name of
Party
(GMSD/
SDS/
DTC/TU)
GMSD
Karnal
Folio No.:
IV-35
(d)
-
(e)
1.11.2008
(f)
(h)
AB
Oct-10
XY Aug-10
(g)
60
(i)
(j)
70
10
(k)
10
10
(l)
60
(m)
(n)
(o)
(p)
(q)
1.11.2008 Op Balance
(b)
Date (Dd/
mm/ yy) of
Transaction
(Receipt/
Issue)
2 10.11.2008
(a)
SL.
NO.
Product Description
Strength
Each combi-pack of
Schedule-5 containing
1 R Tab .of 75mg
1
Product Code 13
1 H Tab. of 75mg
1 E Tab of 200mg
1 Z Tab. of 250mg
Treatment box for pediatric category (11-17 Each combi-pack of
Kg, 18-25 & 26-30 Kgs). Each treatment box Schedule 7 Containing
containing 24 combi-packs of Schedule-7 in 1 R Tab.of 150mg
2
Product Code-14
1 H Tab. of 150mg
one pouch and 18 multi-blister calendar
combi-pack of Schedule-8 in another pouch 1 E Tab of 400mg
1 Z Tab. of 500mg
Treatment box for prolongation of intensive
Each combi-pack of
Schedule - 5 Containig
Product Code-15
phase of pediatric cases (6-10 &18-25 kg).
Each box containing 5 pouches and each
1 R Tab.of 75mg
3
pouch containing 12 blister combipack of
1 H Tab. of 75mg
Schedule-5
1 E Tab of 200mg
1 Z Tab. of 250mg
Treatment box for prolongation of intensive
Each combi-pack of
Schedule 7 Containing
Product Code-16
phase of pediatric cases (11-17, 18-25 kg
and 26-30 kg). Each box containing 5
1 R Tab.of 150mg
4
pouches and each pouch containing 12
1 H Tab. of 150mg
blister combipack of Schedule-7
1 E Tab of 400mg
1 Z Tab. of 500mg
R= Rifampicin; H= Isoniazid; E= Ethambutol; Z= Pyrazianamide; S.M= Streptomycin Inj; X= Pyridoxine
Treatment box for pediatric category (6-10
Kg, & 18-25 Kgs). Each treatment box
containing 24 combi-packs of Schedule-5 in
one pouch and 18 multi-blister calendar
combi-pack of Schedule-6 in another pouch
Unit
Each multi-blister calender combi-pack
of Schedule-6 containing
3 R Tabs.of 75 mg each
3 H Tabs. of 75mg each
4 Pyridoxine Tabs of 5mg each
Each multi-blister calender combi-pack
of Schedule-8 containing
3 R Tabs.of 150 mg each
3 H Tabs. of 150mg each
4 Pyridoxine Tabs of 5mg each
Treatment
Boxes
Treatment
Boxes
Treatment
Boxes
Treatment
Boxes
Drug Management for Pediatric drugs is similar to that of adult PWBs except that Pediatric
boxes are to be stocked only upto the TU level, as currently these boxes are available for
only New cases & any modification to convert these boxes to previously treated regimen
can be done only at the TU level. Conversion of PWBs for new cases to PWBs for
previously treated cases can be shown as below:
Conversion of Pediatric Box for new cases into Pediatric Box for previously treated
cases One Prolongation Pouch would be added to each box to make an IP pouch of 3
months duration.
For prolongation of IP for previously treated cases, one more PP would be added
As the CP pouch of PWBs of new cases would contain drugs for 4 months, a PP
would be added for extra 1 month of CP after removing Pyrazinamide tablets,.
As the 4 months of CP blisters for new cases contain only Cap. Rifampicin and Tab.
INH, so Ethambutol tablets will have to be added from the supplies of loose drugs
under the Programme.
Inj.SM (750 mg) supplied under the programme shall be used for such patients as
per body weight.
164
New Cases
Prolongation for
New Cases
6-10 Kg
One PC 13
Box
One Pouch of PC
15
11-17 Kg
One PC 14
Box
One Pouch of PC
16
18-25 Kg
One PC 13
Box + One
PC 14 Box
One Pouch of PC
15 + One Pouch
of PC 16
26-30 Kg
Tow PC 14
Boxes
Two Pouches of
PC 16
Prolongation
for
Previously
treated cases
One Pouch of
PC 15
One Pouch of
PC 16
One Pouch of
PC 15 + One
Pouch of PC
16
Two Pouches
of PC 16
Chemoprophylaxis : Loose tablets of INH 100 mg are supplied by CTD based on the
district Quarterly Report on Programme Management & Logistics (QRPML)
Requirement of Prolongation Pouches for indoor patients:
The officer-in-charge of the hospitals can obtain these prolongation pouches from their
concerned TUs based on consumption reported in their monthly PHI report.
Requirements of Non-DOTS loose drugs:
In exceptional cases, non-DOTS regimens may have to be used under RNTCP. These
drugs can be obtained, based on actual requirements.
165
All PHIs submit Monthly Report on Program Management and Logistics (MRPML) to
the TUs. The TUs in turn consolidate these reports into QRPML-TU and submit to
the district level.
The district quarterly reports are validated by the State TB Cell based on which
drugs are issued by the SDS before end of the first month after the quarter.
Respective states are also expected to make arrangements for transportation of
drugs from SDS to District Tuberculosis Centres (DTCs). The DTC is responsible for
transporation of drugs to TU and onwards. The district QRPML is submitted to CTD
latest by 24th of the subsequent month after the quarter with a copy to the STO.
It is very important to make sure that every health facility in the district gets
adequate supply of anti-tuberculosis drugs. Timely initiation of treatment is not
possible if the supply of drugs is inadequate. The basis for stocking adequate
amount of drugs at various levels is described in the following paragraphs.
The MRPML from PHI & QRPML from TU, District and State level contain the
following tables for drug position:
PHI Monthly Report on Programme Management & Logistics:
Adult Patient Wise Boxes
Item
(a)
Unit of
Measurement
(b)
PC-1
Patient Wise
Boxes PWBs)
PC-2
PWBs
Stock on
first day of
month
(c)
Stock
received
during
month
(d)
166
Patients
initiated on
treatment
Stock on
last day of
month
Quantity
Requested
(e)
(f)= (a+b)-c
(g)= (c X 2) - d
Unit of
Measurement
Stock on
first day
of month
Stock
received
during month
Consumption
during the
month
Stock on last
day of month
Quantity
Requested
(c)
(d)
(e)
(f)=(c+d)-e
(g)=e 2)-f
Stock on
first day
of month
Stock received
during month
Consumption
during the
month
Stock on
last day of
month
Quantity
Requested
(c)
(d)
(e)
(f)=(c+d)-e
(g)=e 2)-f
(a)
(b)
Prolongation
Pouches
Pouches each
with 12 blister
strips
Streptomycin
0.75 g
Vials
Unit of
Measurement
(a)
INH 300 mg
INH 100 mg
Rifampicin
150 mg
Ethambutol
800 mg
(b)
Tablets
Tablets
Capsules
Tablets
For MRPML of PHI-level, all information is available from the stock register of the PHI
stores. The stock on first day of the month should always be equal to stock on last day of
the previous month. The information on stock received during the month would comprise
of receipts from its TU as recorded in the stock register. Similarly, information on Patients
initiated on treatment would comprise of all the issues i.e. No. of patients put on treatment.
The Closing Stock is then calculated as opening stock + Receipts patients initiated on
treatment. However, this figure will be equal to what is available in the PHI stores also.
Hence, a monthly physical verification should be considered essential to ensure that there
is no difference between the two. To calculate Quantity Requested, the following formula
is used [(No. of patients initiated on treatment x 2)- closing stock]. This will ensure that
the PHI receives its supply from its TU as per stocking norms discussed above.
Similarly, the information about laboratory consumables available in the stock register
maintained in the laboratory is to be filled.
TU Level : Medications
Adult Patient Wise Boxes
Item
Unit of
Measurement
(a)
(b)
PC-1
Patient
Wise
Boxes (PWBs)
PC-2
PWBs
(d)
167
Patients
initiated on
treatment
Stock on last
day of Quarter
Quantity
Requested
(e)
(f)=(c+d)-e
(g)=(e/3 4)-f
Items
(a)
Prolongation
Pouches
(b)
Pouches each
with 12 blister
strips
Streptomycin
0.75 g
Vials
Co-trimoxazole
Monthly pouch
(of 30 tabs.)
Stock on
first day
of quarter
(c)
Stock
received
during the
quarter
(d)
Consumption
during the
quarter
Stock on
last day of
Quarter
Quantity
Requested
(e)
(f)=(c+d)-e
(g)=(e/3 4)-f
Paediatric Patient Wise Boxes (Including drugs for Adult Patients <30kgs)
Items
Unit of
Stock on
Stock
Consumption Stock on last
during the day of Quarter
Measurement first day of received
quarter
quarter
during the
quarter
(a)
(b)
Paediatric PC 13
Boxes
Paediatric PC 14
Boxes
Paediatric PC 15
Paediatric PC 16
(c)
(d)
(e)
(f)=(c+d)-e
Quantity
Requested
(g)=(e/3 4)-f
Pouches each
with 12 blister
strips
Pouches each
with 12 blister
strips
(a)
Unit of
Measure
ment
Stock on
first day of
quarter
Stock
received
during the
quarter
(b)
(c)
(d)
INH 300 mg
Tablets
INH 100 mg
Tablets
Rifampicin
150 mg
Capsules
Pyrazinamide
750 mg
Tablets
Ethambutol
800 mg
Tablets
168
(f)=(c+d)-e
Quantity
Requested
(g)=(e/3 4)-f
Unit of
measure
ment
(a)
(b)
Box
Box
Box
Box
Box
Stock
on first
day of
quarter
(c)
Stock
received
during
the
quarter
(d)
Consumption
during the
quarter
(e)
Stock on
last day of
quarter
Quantity
Requested
(f)=(c+d)-e
(g)=(e 2)-f
Box
Carton of 3
boxes
* PWB for New Cases within 12 months; PWB for previously treated cases within 14 months;
PC 13 & PC 14 - within12 months; PWB for MDR TB Treatment Regimen within 6 months
2. Are there any expired drugs?
(a)
Unit of
Measurement
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
Stock
transfe
rred in
Reconstitution
of boxes
during Quarter
Stock
Transferred
Out *
Patients
started on
treatment
Stock on last
day of
Quarter
Quantity
Requested
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)=(c+d+e+f)
(g+h)
(j)=(h/3 7)
-i
PC-1
PWBs
PC-2
PWBs
169
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
Stock
transferr
ed in
Reconstit
ution
during
Quarter
Stock
Transferr
ed Out *
Consumption
during the
Quarter
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Prolongation
Pouches
Pouches
each with
12 blister
strips
Streptomycin
0.75 g
Vials
Item
Stock on last
day of Quarter
Quantity
Requested
(i) =
(c+d+e+f)
(g+h)
(j) =
(h/3 7) - i
Paediatric Patient Wise Boxes (Including PWBs for Adult Patients <30kgs)
PWBs
(a)
Paediatric PC 13
Paediatric PC 14
Paediatric PC 15
Paediatric PC 16
Unit of
Stock on
Stock
Stock Reconstitution Stock Consumption Stock on last day Quantity
Measurement first day received transferred of boxes Transferred during the
Requested
of Quarter
during the
of
during
quarter
in
Out *
quarter
Quarter
Quarter
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)=(c+d+e+f) (j)=(h/3 7)
(g+h)
i
Boxes
Boxes
Pouches
each with 12
blister strips
Pouches
each with 12
blister strips
(a)
Unit of
Measurement
Stock on
first day
of
Quarter
Stock
received
during the
quarter
Stock
transferred
in
Stock
Transferred
Out *
Consumption
during the
quarter
Stock on last
day of
Quarter
Quantity
Requested
(b)
(c)
(d)
(e)
(f)
(g)
(h)=(c+d+e)
(i) =
(g/3 7) h
(f+g)
INH 300 mg
Tablets
INH 100 mg
Tablets
Rifampicin
150mg
Capsules
Pyrazinamide
750 mg
Tablets
Ethambutol
800 mg
Tablets
Unit of
measurement
Stock on
first day of
the Qtr
Stock
received
during the
Qtr
Consumption
during the
Qtr
Stock on last
day of the
Qtr
Quantity
Requested
for DTC
(a)
(b)
(c)
(d)
(e)
(f)=(c+d)-e
(g)=(e 2)-1
IP ( 45 Kg Body wt )
Box
Box
170
Box
Box
Carton of 3
boxes
* PWB for New Cases within 12 months; PWB for previously treated cases within 14 months;
PC 13 & PC 14 - within12 months; PWB for MDR TB Treatment Regimen within 6 months
2. Are there any expired drugs?
For preparation of QRPML at DTC-level, the TU reports are to be consolidated in the WRDR-DTC
format, which is available in Annexure V and also in the exercise given overleaf. WRDR-DTC
facilitates not only in correct consolidation of the TU reports and thereby helping in the preparation
of the DTC-QRPML but also ensures that quantities as per stocking norms get issued to the TUs.
WRDR-DTC: The data of all the TU reports shall be put in the WRDR-DTC format along with the
information of the stock register at the DTC drug stores. The DTC-QRPML comprises the total of all
the TU Reports & the DTC drug store. Prior monthly physical verification of the DTC-store is
essential for ensuring accurate reporting. However, to calculate Quantity Requested, No. of
patients initiated on treatment/3 x 7 minus total closing stock at TUs & DTC shall ensure that the
DTC receives its supply from its SDS as per stocking norms discussed above
An Exercise on the WRDR-DTC is available overleaf along with the format , Solution to the exercise
is placed at Annexure VI.
STOCK
RECONSTITUTION STOCK
TRANSFERRED OF BOXES DURING TRANSQTR.
IN
FERRED
OUT
PATIENTS
ISSUES TO
STARTED ON TU
TREATMENT/
CONSUMTION
DURING QTR
(h)
(i)
47
XXXXXXX
60
XXXXXXX
107
XXXXXXX
95
XXXXXXX
(d)
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
(e)
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
(g)
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
309
30
62
30
XXXXXXX
331
30
62
30
309
XXXXXXX
Please note that Issues from DTC shall be equivalent to Total Stock Received by all TU during the quarter from DTC.
171
Drug:
Stocking
unit
Stock
on first
day of
quarter
Stock
received
during
the
quarter
Stock
Trans
fered
In
Reconstitution
of
boxes
during
quarter
Total availability of
drugs during
the quarter
Stock
Trans
fered
Out
Patients
started on
treatment/
consumtion
during
quarter
Issues
to TU
(a)
(b)
(c)
(d)
(e)
[f=(b+c+d+e)]
(g)
(h)
(i)
TU 1
XXXXX
XXXXXX
XXXXX
TU 2
TU 3
XXXXX
XXXXX
XXXXXX
XXXXXX
XXXXX
XXXXX
XXXXX
XXXXX
TU 4
XXXXX
XXXXX
XXXXX
TOTAL
TUs (A)
XXXXX
XXXXX
XXXXX
XXXXXX
XXXXXX
Stock
on last
day of
quarter
[j=f(g+h+i)]
Qty.
Requested
[for TU
K= (h/3*4)j]
[for dtc
(h/3*7)- j]
(k)
XXXXX
DTC
Own (B)
XXXXXXX
TOTAL
DTC
(District)
(A+ B)
Unit of
Measure
-ment
Stock
on first
day of
Quarter
Stock
received
during
the
quarter
Stock
transferre
d in
Reconstituti
on of boxes
during
Quarter
Stock
Transferred
Out *
Patients
started
on
treatment
Stock on
last day of
Quarter
Quantity
Requested
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)=(c+d+e+f)
(j)=(h/3 10)
-i
(a)
- (g+h)
PC-1
PWBs
PC-2
PWBs
Stock
on first
day of
Quarte
r
Stock
receive
d
during
the
quarter
Stock
transfe
rred in
Reconstit
ution of
boxes
during
Quarter
Stock
Transfer
red Out *
Consumption
during the
quarter
Stock on last
day of
Quarter
Quantity
Requested
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
(i)=(c+d+e+f)
(g+h)
Prolongation
Pouches
Pouches
each with
12 blister
strips
Streptomyci
n 0.75 g
Vials
Item
172
Stock
Stock
Consumption Stock on
Quantity
Unit of
Stock
Reconstitution
Stock
last day of Requested
Measurement on first received transferred
of during
Transferred during the
day of
during
quarter
Quarter
Quarter
in
Out *
Quarter
the
quarter
(a)
(b)
(c)
(d)
(e)
(f)
(g)
(h)
Paediatric PC 13 Boxes
Paediatric PC 14 Boxes
Pouches each
Paediatric PC 15 with 12 blister
strips
Pouches each
Paediatric PC 16 with 12 blister
strips
Item
(a)
(b)
INH 300 mg
Tablets
INH 100 mg
Tablets
Rifampicin
150mg
Capsules
Pyrazinamide
750 mg
Tablets
Ethambutol
800 mg
Tablets
(c)
(d)
(e)
(f)
173
(g)
Consumption
during the
quarter
Stock on last
Quantity
day of
Requested
Quarter
(h)
Monitoring drugs and logistics is done through a two-tier monitoring system: a central
system at Central TB Division (CTD) and a decentralized system by the State TB Officers
(STOs) and the District TB Officers (DTOs). CTD reviews and ensures drug adequacy at
State and district-level whereas the STOs and the DTOs ensures the same up to the level of
the DOT Centres. CTD ensures drug adequacy at districts by reviewing Quarterly
Programme Management Reports (QPMR) received from the districts which enables
continuous monitoring of drug stock position including verification of Reports giving the
details below:
Stock on the first day of the quarter
Quantity Received during the quarter (including reconstitution and transfers)
Patients started on Treatment during the quarter
Stock on the last day of the quarter
Quantity requested
174
Monthly
Reports
GMSDs
CTD
Qtrly
Reports
Monthly
Reports
State Drug
Stores / STO
Qtrly
Report
s
Qtrly
Reports
Monthly
Report
PHI
Districts
TU
Monitoring cycle
Flow of Drugs: The flow of drugs is the direct reverse of the flow of reports. Drug
requirements, consumption and stock positions, both at State and district levels are
monitored at the Central TB Division through the quarterly reports submitted by the districts.
Regular, accurate monthly PHI Reports as well as their correct consolidation at the TUs &
District levels are hence, essential for correct monitoring of the stock position at various
levels.
Supply of drugs by Central TB Division from the GMSD to the SDS is communicated to the
State through a Release Order. Based on the district quarterly report, stock is supplied from
SDS to the district drug store to its TUs and then to the PHIs.
Hence, at the beginning, the PHIs are supplied with a stock of two months (ie. stock for
utilization in the first month along with a reserve stock of one month). Then every month, as
per the monthly PHI report, they are supplied with stock from the TU which helps to
maintain the reserve stock for a month at the PHI. This reserve stock helps the PHI to
provide drugs if more patients are put on treatment in a particular month and to provide
cover for delay in supplies from TU. Thus no patient is sent back due to lack of drugs even
on a single occasion.
For the TU level to ensure that the PHIs have a months utilization stock plus a reserve
stock of one month, it needs to have a reserve stock of two months at the beginning of the
quarter. This will ensure a continuous supply of drugs.
The regular process of supply of fresh stock of drugs from the GMSD to the SDS/districts
begins only when the districts submit their QPMR reports to the State/CTD (Epi-centre).
Once the QPMRs are received by Central TB Division, it takes around 7-10 days for CTD/
SDS to process the requirement (from all districts of all states). The district should have at
least a utilization stock of 4 months at the beginning of the quarter. Similarly the State Drug
Stores should have at least a reserve stock of 3 months of consumption of the state.
175
Reserve
stock
1 month
TU drug
store
0 months
2 months
DTC
drugstore
0 month
3 months
SDS
0 months
3 months
Level
PHI
Drug requirements
(Monthly consumption x 2) (existing stock in PHI
at end of the month)
(Quarterly consumption / 3) x 4 (existing stock in
TU including PHI drug stores at end of the
quarter)
(Quarterly consumption / 3) x 7 (existing stock in
DTC drug store including TU & PHI drug stores at
end of the quarter )
(Quarterly consumption / 3) x 10 (existing stock
in SDS including stocks at all districts at end of
the quarter)
Thus the quantity of reserve stocks and total stocks at each level at the start of the quarter
(considering the receipt from one higher level) should be as follows:Level
PHI
TU drug store
DTC drug store
State drug store
Utilization
1 month
-
Reserve stocks
1 month
2 months
3 months
3 months
Total stock
2 months
4 months
7 months
10 months
The above described movement of drugs can be further explained in the following manner:GMSDs
SDS
DTCs
TUs
PHIs
176
Duration of
treatment
PC-1
6
PWB
PC-2
8
PWB
* At the district level
Extension
in IP
Possible
Interruption
Max transit
time for
shifting of box
At risk of
expiry, if less
than *
12
14
Note:
Loose drugs can be used till the last date of expiry ie. Drugs with DOE of Dec-09 can be
used till 31st Dec-09
5. Quality Assurance of drugs
Maintaining quality of drugs remains a critical programme requirement. This is enabled
through a system of pre-dispatch & post-dispatch testing of drugs and monitoring of the
quality throughout their shelf-life up to consumption by the patients. The following steps
have been taken by the Programme in ensuring best quality drugs:
Reconstitution
Partially used boxes in case of defaults, failure, transferred out and death of a patient are
sent to district tuberculosis center and are reconstituted. Partially used boxes are at the risk
of expiry if they are not reconstituted. This should be performed at the DTC and carried out
under the direct supervision of the DTO. Complete information about failure, default, death
and transferred out cases, including TB number, name of PHI and number of blisters
remaining unused in the category wise boxes should be made available and recorded in the
Reconstitution Register(RR), format as in Annexure IX maintained at the DTC level.
The Reconstitution Register contains several columns wherein the details / number of
remaining IP/CP blister from partially used boxes are to be put in the respective columns at
the end of each quarter or as & when the reconstitution exercise is to be taken up. At the
177
178
179
180
EXERCISE
In this exercise you will calculate the number of sputum containers and slides needed by a
district for the current quarter.
According to the Quarterly Report on New and Retreatment Cases, Thane District began
treatment of 80 New pulmonary smear-positive cases, 20 9retreatment (smear-positive)
cases and 60 pulmonary smear-negative cases last quarter. There were 125 sputum
containers and slides currently in stock in the beginning of the quarter.
Calculate the number of sputum containers and slides needed for the quarter.
Answer the following questions:
1. How many sputum containers should you order for Thane District?
181
182
The patient to be transferred, to hand over to the PHI where he reports for
continuation of treatment
2. Add an extra 20% of the number of forms needed to take care of the increase in
tuberculosis cases or lost forms.
To account for the increase in tuberculosis cases and lost forms, add an extra 20% of
the number of forms needed. You do not have to make this calculation for the
Tuberculosis Register or the Tuberculosis Laboratory Register, because one of each
register should be sufficient for one year. Each TU will register approximately 150
cases/lakh/year x 5 lakhs = 750 cases/year. At least 1000 patients can be registered in
one register.
Initially, two registers are needed per TU so that there is no gap between the first and
second year of service delivery. The Tuberculosis Laboratory Register allows for
registration of at least 2000 patients. For each lakh, 75 smear-positive patients are
projected, requiring the examination of 750 patients . Additional follow-up examinations
will bring the number of registers needed to approximately one lab register / lakh.
184
185
EXERCISE
From the information provided about the Birbhum District, list the types and number of
tuberculosis forms you need to order for this district to last throughout the next year.
Case: Birbhum District
In 2008, in Bolpur TU of Birbhum District, there were 220 tuberculosis patients, of whom
100 were diagnosed as new pulmonary smear-positive cases. There are 5 microscopy
centres in the sub-district. In this year, 8 patients from the sub-district were transferred to
another sub-district. Approximately 10 culture/sensitivity examinations were done in the
same year. At this time, you need to order tuberculosis forms and registers for 2009. The
following number of tuberculosis forms and registers are available in the reserve stock:
50. Tuberculosis Treatment cards
10 Transfer Forms
35. Tuberculosis Identity Cards
6 Tuberculosis Laboratory Registers
82. Laboratory Form for Sputum
3 Tuberculosis Registers
Examination
15. Mycobacteriology Culture/Sensitivity Test
Forms
Tuberculosis
Form/Register
Number
required
Add 20%
Subtract Stock
Net number
EXERCISE
1. What should be the reserve stock of drugs at the district level?
2. In Katurma District, 40 smear-positive cases were registered during the third quarter of
year 2008. Calculate the total number of sputum containers needed for diagnosis.
3. What is the basis for calculation of drug stocks?
4. What is the purpose of maintaining reserve stock?
d) Binocular Microscopes (BMs)
Sputum Microscopy is an essential part of RNTCP. It plays a major role in the
programme and hence procurement of BMs is an important component in RNTCP and
the procurement of binocular microscopes is undertaken by CTD and are delivered to
the States / Districts. All BMs should be covered by annual maintenance contracts by
states/districts, at the end of their warranty periods.
186
Uninterrupted supply of drugs and other materials is critical to the success of TB Control
Programme.
Drug requirements are based on the number of cases, existing stocks, and reserve
stocks.
Reserve stocks are required to account for unexpected increase in TB case load, delays
in procurement and distribution of drugs, improper distribution of drugs, and pilferage of
drugs or lost due to improper storage.
Ensure regular physical verification of drugs and other materials at all levels.
AMC of BMs & IRL equipments and regular maintenance of vehicles should be ensured.
187
available
for
months
at
DTC,
Quantity
Atleast 1 per DMC
3,300
3,300
3,300
1 number
1 number
1 number
1 number
2 numbers
33 boxes + 1-2 per
DMC for RBRC
Tissue rolls
4 numbers
Grease marking pencil
12 numbers
Absorbent cotton, 500 gms/ roll
4 numbers (2 k.g)
Pressure cooker, For disposal by autoclaving
Optional
5% phenol
600 litres
Methylated spirit
3 liters
Aprons
2
Disposable gloves, 6 and 8 inches (box of 25 pairs)
12 boxes
Spirit lamp,
1 number
Metal wire, For swab for heating of Carbol fuchsin
1 number
Sputum specimen transport box, Insulated box, made of plastic 10 x 2 numbers
10 x 10, thickness 1 with lid, handle and nylon belt 1 width 2.5
feet length, nylon strap of 1 width 2 feet length with Velcro to strap
the lid of the box from side to side.
For preparation of reagents at DTC/TU
Reagents/ Equipment for staining
Basic fuchsin, Pararosaniline hydrochloride, C19 H18 N3 Cl, molecular
wt: 323.8, Colour: Metallic green, Dye content: Should be available
on the container. Approximately 85%-88%
Carbolic acid (Phenol), C6H5OH, and molecular wt: 94.11, Melting
point: 400C, Solidification point: 40.50C, Purity: 99.5%
Sulphuric acid: H2SO4, molecular wt: 98.08, Purity: 95-97%, Colour:
Clear
Methylene blue, (Methylthionine chloride), C16H18CIN3S, molecular
Wt: 319.9 Dye content: Should be available on the container.
Approximately 82%
Alcohol (absolute)
Funnel, 7 dia 7 height and 5 stem height
Funnel, 3 dia 4 height and 5 stem height
Drop bottles, Glass/ plastic 100 ml capacity
Bottles for storage of stock solutions, Brown bottles
188
Quantity
300 Gms
2 ltrs
10 ltrs
32 Gms
3.2 ltrs
4 nos.
4 nos.
8 nos.
4 nos.
5 nos.
6 nos.
2 nos.
2 nos.
4 nos.
4 nos.
1 no
1 box
6 rools
As per requirement
1 no.
1
1 no.
1 no.
35 liters
1
2200
2
189
Number needed
2 per patient
1 per patient
1 per year per TU
1 per year per microscopy Centre
15 per new pulmonary smear-positive
case
Number determined by State tuberculosis
Officer
16 per year (4 copies x 4 quarters) for
each TB Unit and for DTC
16 per year (4 copies x 4 quarters) for
each TB Unit and for DTC
16 per year (4 copies x 4 quarters) for
each TB unit and for DTC
190
Folio No. :
29.11.08
DTC - C
DTC-B
DTA- 68
IV-14
IV-35
8.11.08
1.11.08
AB
EF
AB
XY
CD
AB
XY
SIV 3 29.11.08 CD
SIV 2 26.11.08
12.11.08
SIV 1 17.11.08
SIV 1 17.11.08
Nov-10
Oct-10
Dec-11
Oct-10
Aug-10
Nov-10
Oct-10
Aug-10
10
50
60
40
40
20
10
20
60
100
90
110
120
70
10
10
10
10
40
40
60
60
60
10
50
50
50
50
50
10
10
10
Notes:
1. Use a separate sheet for each drug item
2. PHIs shall receive their stock requirements each month from their respective TUs.
3. In the case of Loose Drugs, report Consumption of Drugs During Quarter in column (h) instead of Patients Started on Treatment During Quarter
4. Issues from TU shall match with the total of stocks received by all PHCs, serviced by the TU.
26.11.08
17.11.08
SDS Delhi
DTC A
17.11.08
25.11.08
DTC-A
1.11.08
Op Balance
SL.
NO.
ANNEXURE - III
Stock on
first day
of
the
quarter
Total Stock
Received
during the
Qtr.
[f=(c+d+e)]
Month 3
(i)
Xxxxxxxx
(j)
Total
Stock
Received
during the
Qtr.
[i=(g+h+i)]
Xxxxxxxx
Xxxxxxxx
Xxxxxxxx
Xxxxxxxx
(k)
Issues to
PHIs
(l)
Stock on
the last
day
of
quarter
[I=(b+f-jk)]
Xxxxxxxx
(m)
Xxxxxxxx
xxxxxxxx
Xxxxxxxx
Xxxxxxxx
Xxxxxxxx
Quantity
requested
for Total
TU: (i/3 x
4)-I]
4. Issues from TU shall match with the total of stocks received by all PHCs, serviced by the TU
2. PHIs shall receive their stock requirements each month from their respective TUs.
3. In the case of Loose Drugs, report Consumption of Drugs During Quarter in column (h) instead of Patients Started on Treatment During Quarter
Notes:
1. Use a separate sheet for each drug item
* Total Drug stocks shown as 'receipt by the TU s' should match with the Total drugs shown as 'Issued to TU s' at the district level.
Month 2
(h)
Month 1
Month 2
Month 3
Month 1
(a)
(b)
(c)
(d)
(e)
(f)
(g)
PHI 1
PHI 2
PHI 3
PHI 4
Total
Stock at
PHIs
TU
on
stock
position
Total
Stock
position at
TU
PHI shall receive their stock requirement each month from their respective TUs.
Stocking
Unit
Name of Drug:
Medical Officer - TU
ANNEXURE - IV
XXXXXXXX
TU 3
(e)
XXXXXXXX
XXXXXXXX
XXXXXXXX
Reconstitution
of boxes during
the quarter
Drug:-
(f)
Total availability of
drugs
during the
quarter (f
= b+c+d+e)
XXXXXXXX
XXXXXXXX
XXXXXXXX
(g)
Stock
transferred
out
(h)
Patients
started on
treatment/
consumption
during quarter
DTC:-
XXXXXXXX
XXXXXXXX
XXXXXXXX
(i)
Issues to
TU s
(j)
Stock on
the last
day of
quarter [
j = (f - g h- i)]
XXXXXXXX
(k)
Quantity
requested
[for TU: (h/3
x 4) j] [for
total DTC:
(h/3 x 7) -j]
Notes:
1. Use a separate sheet for each drug item
2. In the case of Loose Drugs, report Consumption of Drugs During Quarter in column (h) instead of Patients Started on Treatment During Quarter
3. Issues from TU shall match with the total of stocks received by all PHCs, serviced by the TU
TU 4
XXXXXXXX
XXXXXXXX
XXXXXXXX
XXXXXXXX
TOTAL
stock
position at
TU s
XXXXXXXX
XXXXXXXX
XXXXXXXX
XXXXXXXX
DTC Own
stock
position
*
XXXXXXXX
TOTAL
stock
position at
DTC
*
* Total Drug stocks shown as 'receipt by the TU s' should match with the Total drugs shown as 'Issued to TU s' at the district level.
XXXXXXXX
(d)
TU 2
( c)
Stock
transferred
in
XXXXXXXX
(b)
(a)
Stock
received
during
the
quarter
TU 1
Stock
on first
day of
the
quarter
Stocking
Unit
ANNEXURE - V
584
221
30
30
XXXXX
XXXXX
X
XXXXX
X
XXXXX
X
XXXXX
X
(d)
STOCK
TRANS
FERED
IN
62
62
XXXXXX
XXXXXX
XXXXXX
XXXXXX
XXXXXX
(e)
RECONSTITUTIO
N OF
BOXES
DURING
QUARTE
R
897
472
425
190
114
61
TOTAL
AVAILABILITY OF
DRUGS
DURING
THE
QUARTER
[f=(b+c+d+e)
]
60
30
30
XXXXX
XXXXX
XXXXX
XXXXX
XXXXX
(g)
STOC
K
TRAN
S
FERED
OUT
309
XXXXXXX
309
95
107
60
47
(h)
PATIENTS
STARTED
ON
TREATMENT/
CONSUMTIO
N DURING
QUARTER
331
331
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
XXXXXXX
(i)
ISSUES
TO TU
227
111
116
95
[j=f(g+h+i)]
13
STOCK
ON LAST
DAY OF
QUARTER
494
198
296
31
136
79
50
(k)
QTY.
REQUESTED
[FOR TU
K=(h/3*4)-j]
[FOR DTC
K=(h/3*7)- j]
Notes:
1. Use a separate sheet for each drug item
2. PHIs shall receive their stock requirements each month from their respective TUs.
3. In the case of Loose Drugs, report Consumption of Drugs During Quarter in column (h) instead of Patients Started on Treatment During Quarter
4. Issues from TU shall match with the total of stocks received by all PHCs, serviced by the TU
*Total drug stocks shown as 'receipt by the tu's should match with the total drugs shown as 'issued to tu s' at the district level.
253
143
127
47
TU 4
95
331
19
TU 3
48
45
(c)
STOCK
RECEIVED
DURING
THE
QUARTER
94
13
TU 2
TOTAL
TUs (A)
DTC Own
(B)
TOTAL
DTC
(District)
(A+ B)
15
(b)
(a)
TU 1
STOCK ON
FIRST DAY
OF
QUARTER
STOCKING
UNIT
ANNEXURE VI
Month:
Sl.
No.
Item
UOM
(a)
(b)
1
2
3
4
5
6
7
8
9
10
11
12
13
PC-1
PC-2
Prolongation Pouches
Rif-450mg
INH-100 mg
Pza-750 mg
Inj-SM 0.75 g
INH-300 mg
Eth-800 mg
PC-13
PC-14
PC-15
PC-16
PWB
PWB
Pouches
Caps
Tabs
Tabs
Vials
Tabs
Tabs
PWB
PWB
Pouches
Pouches
Opening
Receipts
Balance Receipts Drugs
During Trfd. In
the Month
(d)
(e)
(f)
Total
Stores
(g =
d+e+f)
ISSUES
Balance
Stores
Store
Drugs
with
DOE
Supplied Trfd. Out
(h)
(i)
[j = g-(h+i)]
195
PC-1
PC-2
Prolongation
Pouch
Inj SM 0.75 g
Rif 150 mg
Pza 500 mg
INH 100 mg
Etha. 800 mg
INH 300 mg
Vials
Capsule
Tablet
Tablet
Tablet
Tablet
(c)
PWB
PWB
Pouch
(d)
QUANTITY
ISSUED
(e)
(f)
(g)
(h)
_______________________________
Signature of Recipient Storekeeper
__________________________
Signature of Recipient Officer
________________________________________
Signature and Stamp of Transporter (for SIV)
(i)
REMARKS
Notes:
(1) Stores Register Folio No. is to be given both by the issuer and recipient of drug stocks and comprises the page number of the Stock Register on which the issue/
receipt is recorded (2) Signature and stamp of the storekeeper/ authorized signatory of both the issuing and the recipient unit are to be provided in the SIV/DIV.
_________________________
Signature of Issuing Officer
____________________________
Signature of Issuing Storekeeper
KEY: UOM: Unit of Measurement; LR: Lorry Receipt; RR: Railway Receipt; ST: State Transport Receipt
3
4
5
6
7
8
1
2
(b)
(a)
UOM
Name of Item
S. NO.
Dispatch Particulars:
Issue Particulars:
Total
Transfer of
PP stock from
Stock
Register Folio
Reconstituted
Regimen for
new cases
Reconstituted
regimen for
previously
treated cases
Total
(c)
Opening
Balance
DOT/PHI
(from which
drugs have
been
transferred
(d)
TB
Register
No.
(e)
Treatment
Regimen
(New/Previously
treated)
(f)
IP of New
cases (24
Blister
Combipacks)
(g)
(h)
Previously
treated
cases
New
Cases
(i)
(l)
(m)
KEY: Treatment regimen for new/previously treated cases; IP: Intensive Phase; CP: Continuation Phase
1. Reconstituted IP & CP need to be put in poly bags with stickers on them, clearly mentioning that they comprise reconstituted IP or CP Pouches
2. DOE of the reconstituted Box to be reported in Column (l) shall comprise the DOE of drugs used having the latest DOE
3. Any loose drugs generated in the process may be used for patients put on non-DOTS treatment, or otherwise
4. Reconstitution should be done under supervision of the DTO every quarter. DTO may instruct for reconstitution at shorter intervals, if required
30.11.10
30.11.10
31.11.10
(b)
(a)
1
2
3
4
DATE
s.
No.
ANNEXURE IX
RECONSTITUTION REGISTER (RR)
PC-2 PWB
Prolongation Pouches
Isoniazid-100mg
Rifampicin-150mg
Pyrazinamide-750mg
Inj.Streptomycin-0.75g
PC-13 PWB
PC-14 PWB
PC-15 PP
PC-16 PP
198
Table of Contents
Module 8
Program Supervision and Evaluation
Learning Objectives .....................................................................................
Introduction .................................................................................................
Objectives of supervision ............................................................................
Preparation for supervision visit ..................................................................
Discussion with medical officers and health workers ..................................
Review of record .........................................................................................
Observation ................................................................................................
Examination of supplies ..............................................................................
Problem solving ...........................................................................................
Modalities of supervision .............................................................................
Maintenance of supervision record ..............................................................
Points to be remember ...............................................................................
Annexure I ................................................................................................
Evaluation ...................................................................................................
201
201
202
203
204
204
205
206
206
208
209
211
213
220
MODULE 8
Program Supervision and Evaluation
Learning objectives:
Objectives of supervision
Supportive supervision: principles and process
Preparation for supervisory visits
Conducting supervisory visits
Problem Solving during supervisory visits
Operationalizing Supervision
Maintenance of Program Supervision records
Conducting Evaluation
Introduction
In the earlier modules, we have learnt about various activities that are to be undertaken to
diagnose and treat TB patients. These activities are performed according to the guidelines
of the program and require a combined effort of different categories of staff possessing
diverse skills at various levels of the health system. The scope of activities and operations
in RNTCP is large and involve not only multiple processes but also a large number of
human resources to implement and manage the program. In order to ensure that all
components of the program run smoothly, a well structured supervision strategy is key to
the success of the program
It is important to remember that supervision is an on-going process not just an event.
Supervision is a comprehensive exercise aimed at maintaining proper work
standards, building the capacities of the health staff and improving the deficient
areas using a constructive and practical approach. It also ensures replenishment of
supplies and stocks. Supervisory visits to health facilities give an opportunity to the
supervisor to review the performance and provide technical advice and guidance to the
health staff. This equips them to perform their activities correctly and confidently thereby
developing their knowledge, sharpen their skills and increasing their involvement in the
program activities.
Supervision is also accompanied by prompt corrective actions taken at the work spot. It is
to be remembered that it is not a fault finding mission. The health staff should feel
confident and find a guiding force in the team supervising the activities in the field.
Supervision should be performed at all levels of health system. Regular supervisory visits
should be conducted with emphasis on helping the health staff to identify and solve
problems. They also need feedback on their performance and encouragement in their work.
This will create a good working relationship among various categories of health staff and
.encourage a collaborative approach to problem solving.
A good supervisor is a FRIEND, PHILOSOPHER and GUIDE for his colleagues and
subordinates
Supervisory
visits give the health staff the opportunity to interact with higher levels. The
201
Objectives of supervision
The following are the objectives of supervision.
To build capacity of the health staff to implement the program procedures correctly.
To ensure that the data recorded and reported is accurate and valid.
To incorporate a system of analysis and review aimed at improving the quality of
programme implementation.
To increase the involvement and commitment of staff at different levels.
To provide actionable and timely feedback
To ensure equitable provision of services to all sectors of the community, including
vulnerable areas and marginalized population (urban slums, tribal / SC / Minority
pockets)
To evaluate the impact of training on the performance of health staff.
Assess re-training needs.
To assess the stocks and replenishment of supplies.
Supportive Supervision
The supportive supervision approach emphasizes on:
Constructive feedback,
Process of Supervision
202
Cure rate for new sputum smear-positive patients is less than 80%
6. Supervisory Team:
Supervisory team should possess a mix of skills and competencies keeping in mind the
key areas and the sites to be visited.
II CONDUCTING SUPERVISION
Supervision is generally carried out with prior intimation to the concerned officials It can
also be undertaken as a surprise visit occasionally.
The supervisory visit should be conducted in an open and congenial atmosphere
encouraging two way communication and joint problem solving.
There are several ways in which the information could be obtained during the visit.
Identified priority areas will require a mix of approaches, some of which are mentioned
below:-
2. Review of records
Efficiency of the performance can also be assessed through review of important
documents. Records that should be reviewed include:
Lab register
Treatment cards
Referral for treatment form and register (if available)
Transfer form
Register for drugs and consumables
Register for supervisory visits
TB register
The information entered in more than one record is compared and checked for consistency.
For example, the results of sputum examination are entered in lab register, treatment card
and TB register. Random checking of such information in various records should be done to
204
3. Observation
a) Observation of activities
On-site observation of various programme activities during their actual performance
is one of the most effective tools for supervision. The activities at DMCs and DOT
centers may be observed closely to assess the adherence to the programme
guidelines. Immediate feedback should be provided on the work performed. While
the correct practices should be acknowledged, any deviations observed should be
communicated with the intention of improving systems and processes rather than
targeting the individual .
b) Observation of Interaction between health staff and patients
Observing interactions between MO/Health staff and patients is crucial for
understanding how the programme is functioning and the areas that require
improvement.
At Health Centre:
Observing the interactions during various activities like sputum collection, DOT,
health education, etc. will help the supervisor to understand the information provided
to the patients and the manner in which it is provided. The supervisory team should
take note of the following:
Home visit : Interaction with the patients and their families is crucial to gauge
patients understanding of the disease he/she is suffering from and the course of
treatment to be followed. This also provides an indication of the quality of health
service delivery. Selection of patients to be visited at their home will be at the
discretion of the supervisory team. However, smear positive patients and patients
who have interrupted the treatment should be given preference. It would be
preferable if the in-charge of the health facility accompany the team during home
visit. Feedback on the observations made during the supervisory visit should be
205
4. Examination of supplies
The following items are to be checked to assess the adequacy:
Drugs
Needles and needle cutters
Syringes
Ampoules of water for injections
Sputum containers
Laboratory consumables
Equipments are checked for their functional status. Reagents are checked for date of
preparation and expiry. Patient-wise boxes are also checked. It is to be ensured that drugs
and reagents with earlier expiry date are used before the stock with later expiry date. Drugs
or consumables should not be kept beyond their date of expiry. During supervisory visits,
unused portions of patient-wise boxes of patients who have defaulted, died or transferred
out are to be taken back to DTC. The partially consumed boxes are not to be re-used for
any other patient, as this may result in incomplete treatment. However the unused blister
packs will be used for reconstitution at DTC.
The stock of drugs and lab consumable is cross-checked with monthly PHI- reports and
registers, followed by physical verification of the existing stock.
Recording feedback on supervision
Observations and recommendations arrived at during the supervision should be entered in
the register meant for supervision. Besides, a report on feedback of supervision should be
sent promptly to the health centre visited for corrective actions. Higher authorities may be
furnished with a brief report for any administrative intervention if needed. Feedback and
problem solving are key to effective supervisory activity.
Problem solving
Problem solving is one of the important objectives of supervision. The steps for solving
problems are described below.
Step 1
Description of the problem identified during supervision by answering these questions
Step 2
Possible causes are identified by answering these questions
Whether the person is aware of the responsibility and has been told to complete the
task?
Does the person have the skill or knowledge to do the task assigned?
Is the person willing to do the task?
Are there obstacles preventing the person from doing the task?
Step 3
Identify and implement the solutions. The specific solution depends upon the cause(s) of
the problem. Solutions that one arrives at should be:
Exercise
Problem identified
STS has reported that he has recently found about 30% cases who have previous history of
anti-TB treatment for more than 1 month are receiving treatment regimen for new cases in a
certain PHC.
207
MODALITIES OF SUPERVISION
The recommended modalities for supervision by different categories of staff are presented
in the table below:
Supervisor
Methodology
DTO/MO
DTC
MO-TC
Frequency
STS
STLS
208
Problems identified
Administrative (
HRD and Financial)
Diagnostic, Drugs
and Lab
consumables ,
DOTS and Follow
up, Records and
Reports, IEC/
ACSM,PPM)
Recommendations
with persons
responsible and
Time frame
Follow up actions
taken, based on
the previous
recommendations
Name and
Signature of
supervisor
Comments from
Program Manager
(DTO/STO)
Date :
209
EXERCISE 1
1. What are the main objectives of supervisory visits?
7. What aspects of drug supply and stores should be checked during supervisory visits?
8. Which type of patients get the highest priority during supervisory visits?
9. Name the three most important records that must be checked and verified during
supervision?
210
EXERCISE 2
In the following case studies, work with other participants to develop a checklist for a
supervisory visit. The facilitator will provide you with background information about the
health facilities.
Case Study 1
You have planned a supervisory visit to a designated microscopy centre. During your
preparation for the visit, you have found that the sputum positivity rate is low in the DMC.
Prepare a checklist to investigate this problem. What are the probable causes and
solutions?
Case Study 2
You have planned to visit a PHC. The STS has reported recently that low proportions of TB
cases are being administered directly observed treatment as per guidelines. Prepare a
checklist to investigate the situation. Suggest measures to solve the problem.
EXERCISE 3
Conduct a site visit to the health facility. The facilitator will explain the details of this visit.
Use the checklist you developed. After the site visit, there will be a group discussion on any
problems your group found and the solutions you recommend. Use the worksheet on the
opposite page to record your groups findings and recommendations. Your group will then
present its findings and recommendations to the other participants in the course.
Points to remember
212
ANNEXURE-1.
FORMAT FOR ADVANCE TOUR PROGRAMME
MEMBERS OF THE SUPERVISORY TEAM
(NAMES /DESIGNATIONS AND DUTY STATION)
1.
2.
3.
DATE:
Period
Place of visit
(Dates/From
- to)
Whom to visit
Review of resources
Observations
Have civil works been done in the Lab as per RNTCP guidelines?
10
Are the Lab Forms for Sputum Exams filled correctly, completely and
legibly?
Are two sputum smears done for diagnosis for all pulmonary TB
suspects?
Are there two sputum smears done for follow-up for all eligible
patients?
Does the Lab register have the summary abstract completed at the
end of each month?
10
11
12
13
14
15
Did the LT check to ensure that the Lab Form was complete and
correct?
Is the sputum container clearly labeled on the side and not on the lid?
Are each set of sputum samples from a single patient given a single
Lab Serial Number?
Does the LT engrave the Lab Serial Number on each slide with a
diamond marker?
Does the LT use a different broom stick for each sputum smear?
Are the sputum smears made on the slide of the correct size (2 cm x 3
cm) and thickness?
Does the LT wait for the slide to dry before heating the slide to fix it?
When the Lab technician fixes the slide by heating, does he do it for
the proper duration of time?
Is only freshly prepared carbol fuchsin being used, instead of readymade commercially-available solutions?
10
Does the LT tilt the slides after rinsing with water to remove excess
water?
11
Is the sulphuric acid allowed to stand on the slide for the appropriate
time period (24 minutes)?
12
Is the methylene blue allowed to stand on the slide for the appropriate
time period (30 seconds)?
While placing immersion oil on the slide, does the LT take care to
avoid touching the slide with the applicator?
While examining the slide with the X100 lens, does the LT take care
to make sure that the lens does not touch the slide?
Does the LT see 100 fields before declaring the smear as negative?
Does the LT clean the X100 lens with lens paper or fine silk after
completing the examination?
Are slides correctly cleaned and maintained serially in slide boxes for
review by the supervisor?
215
10
After examining the slides, does the LT put the sputum containers
and lids (with lids removed) along with the broom sticks, into a footoperated bucket containing 5% phenol?
11
Does the LT break all the remaining slides of the previous month
after the EQA procedure is completed
12
Do the patients know when they should return for the next sputum
exams?
Do the patients find the timings and location of the Lab convenient?
B. Treatment Aspects
Sl
No
Review of TB Register
Observations
216
Observations
Check-points
Does the patient know the correct duration of treatment for his
TB?
Did the patient take all the 24 doses under direct observation in
the IP?
10
11
Observations
13
14
15
16
17
Is retrieval action taken within one day during the intensive phase
and within one week during the continuation phase?
Are sputum cups lab forms etc available with DOT providers?
Observations
Check-points
218
Observations
Is it locked?
Are all drugs kept off the floor and away from the wall?
Sl
No
Observations
Sl
No
Whether all MDR-TB patients diagnosed are referred to DOTSPlus site for initiation of treatment?
219
Observations
Observations
EVALUATION
Program Evaluation refers to assessing the efficacy of the program on identified
parameters. Evaluation is closely linked to the process of supervision and share similar
objectives of addressing deficient areas and improving the quality of overall program
implementation
Evaluation is being done at state level and central level on a periodical basis with members
from other state, adjacent district, representatives from national institutes and Central TB
Division.
Besides, Government of India along with the WHO organizes evaluation of the programme
by international panel of experts from the field of public health, TB research and treatment,
medical education and other related sectors. This is undertaken as joint monitoring mission
once in three years.
Internal Evaluation
Intensive supervision and monitoring at all levels is critical to the success of the RNTCP.
The state level Internal Evaluation (IE) is a tool for comprehensive review of the programme
in a district with the purpose of giving specific recommendation to improve the programme
performance. The objectives of IE of the districts by the state are as follows:
1. Validation of the cure rates of the district with reference to the last quarter reported;
2. Assessment of the programme performance as well as financial and logistics
management;
3. Recommendations for improving the quality of recording and reporting and
4. Recommendations for improving the performance (with a time line)
The State TB Officer has the overall responsibility of coordinating the IE. The members of
the IE team comprise of various state level and district level officials. The DTOs of
neighboring districts are also invited to be a part of the team as this facilitates the exchange
of experiences. Similarly members from the local medical colleges can be invited to
participate in the IE team. Representatives of NGOs and other partners who are trained in
the programme and also in IE protocol can also be part of the IE team
The States are expected every quarter to select two districts for internal evaluation, based
on the latest quarterly reports. Ideally the districts selected should be one well performing
district and one poorly performing district. In states where there are less than 4 districts
implementing RNTCP, then 1 district per quarter may be evaluated, alternating the
selection of district in each quarter. The STO is expected to send the names of the districts
planned for IE, along with the proposed dates of the evaluation to the Central TB Division.
The detailed IE protocol has been circulated to all the states. In brief, the focus is on
interviewing patients, the District TB Officer and his team, to identify issues, which need
improvement, and collectively recommend the course of corrective action.
Designated Microscopy Centres and DOT Centres are selected for evaluation depending
on certain criteria given in the protocol. Subsequently a number of patients, mainly new
sputum smear-positive pulmonary TB cases, are visited and interviewed. Also a sample of
re treatment patients, pediatric patients, MDR-TB patients and TB/HIV patient if available
220
221
Table of Contents
Module 9
Managerial Skills for TB Program Managers
Learning Objectives ................................................................................................................
Use of management in revised NTCP ....................................................................................
Discipline of management ......................................................................................................
Basic functions/roles ...............................................................................................................
Key Management challenges .................................................................................................
Managerial style .....................................................................................................................
Key task for program manager ...............................................................................................
Difference between a manager & leader ................................................................................
The importance of situation ....................................................................................................
Managerial skills for effective program manager ....................................................................
Key learning points of communication ....................................................................................
Build a team ...........................................................................................................................
Managing staff performance ..................................................................................................
Feedback ...............................................................................................................................
225
225
227
227
228
228
230
232
234
235
237
238
240
241
Module 9
Managerial Skills for TB Program Managers
Learning Objectives
In this section, the participants will learn about the following:
Overview of the discipline of Management
Human Resource Management
Key Management Challenges
Managerial Styles of effective TB Program Managers
Key Tasks of TB Program Managers
Key Skills of Program Managers
a) Communication
b) Team building
c) Building partnerships
d) Managing performance
Conclusion
Use of Management in Revised National Tuberculosis Control Program
Tuberculosis continues to be a major public health challenge for India, complicated further
by the emergence of multi-drug resistant TB and TB- HIV co-infections. It has therefore,
become critical, more than before to ensure the provision of quality services through well
managed national TB control program to meet these challenges.
It is in order to meet a felt need to enhance the management and leadership skills within the
National TB Control Programs that a module specifically addressing these issues has been
developed within the RNTCP Modular training package for program managers.
The successful control of TB will largely depend upon the strength of TB control activities at
all levels. Strong management of healthcare facility and hospital staff is imperative for the
implementation and adequate TB control activities.
From a public health perspective, poorly supervised or incomplete treatment of TB is worse
than no treatment at all. The problem however cannot be attributed to just lack of an
effective treatment, but to a lack of systematic and structured management mechanisms to
address all components of the program.
As a program grows, its important to ensure that anyone in a managerial position,
particularly those at line/program manager level, have a good understanding of the
application of management principles of which HRD is a core component.
What is meant by Human Resource Development?
Human Resource Development (HRD) is set of systematic and planned activities designed
by an organization /program to provide its members with the skills and competencies to
meet current and future job demands.
Human resource development is a part of Human Resource Management and it deals with
the all round development of an employee within an organized framework from the time
they join the an organization to the time they leave.
225
The focus of all aspects of Human Resource Development is on developing the most
superior workforce so that the program can accomplish its goals of universal access to TB
care. In the module, health workforce/human resources development is used
interchangeably. HRD in this context refers to the process of planning, managing, and
supporting the health workforce for comprehensive TB control within overall health
workforce development.
What should be the vision when we plan for Human Resource Development in our
area?
Vision
To achieve the ultimate goal of Revised National TB Control Program which is to ensure
universal access to TB care services through sufficient, competent, committed and
motivated human resource.
What should be the ultimate goal we would like to achieve when we strategize our
efforts towards effective management of human resource in our area?
Goal
To support human resources development for Revised National TB Control Program with a
view to develop a health workforce which is responsive and sensitive to health needs of the
population.
HRD and Universal Access
In order to strive towards universal access to TB care, it is imperative that Program
Managers take a proactive role for developing and supporting strategic approaches for
competence development of the staff and creating an enabling environment for all the staff
involved in RNTCP; as well as coordinating their efforts with overall health workforce
development.
Evidence is now available to demonstrate that the number and quality of workers are
positively associated with positive outcomes.
226
Health interventions cannot be carried out without health workers. Developing a competent,
motivated and supported human resource is therefore essential for overcoming obstacles to
achieving national and global health goals. Therefore, it is the responsibility of every
program manager to take a challenging and analytical perspective on how people are
managed in the program.
Revised National TB Control Program envisages a paradigm shift in the role of program
officers at the district and state level from a purely clinical role to managerial role.
Following the widespread implementation of DOTS by national TB control programs in
several countries, it became increasingly clear that the major obstacles to TB control
programs were no longer only technical in nature. The running of a large national TB control
Program required increasingly better management, communication and leadership skills on
the part of the TB program managers at National and intermediate levels of the program.
Discipline of Management
Management in all organizational/program activities is the act of getting people together to
accomplish desired goals and objectives using available resources efficiently and
effectively. Management comprises planning, organizing, staffing, leading or directing, and
controlling the program or effort for the purpose of accomplishing goals or objectives
Basic functions/Roles
Management operates through various functions, often classified as planning, organizing,
staffing, leading/directing, and controlling/monitoring.i.e
Planning: Deciding what needs to happen in the future (today, next week, next
month, next year, over the next 5 years, etc.) and generating plans for action.
Organizing: making optimum use of the resources required to enable the successful
carrying out of plans.
Staffing: Job analyzing, recruitment, and hiring individuals for appropriate jobs.
SWOT Analysis
Internal
assessment
Strengths
Weaknesses
External
assessment
Opportunities
Threat
2. Financial Management: This area poses challenges that focus on identifying various
parameters for budget preparation and evaluation of actual financial performance; to
design the appropriate management information system for periodic reporting of actual
results; and to take corrective action in order to ensure that the process of fund
utilization is efficient and effective.
3. People Management: A Program Manager has certain basic responsibilities such as
setting goals and objectives, planning, resource mobilization, supervision and
monitoring. However as a program manager, you also have a very important
responsibility of developing and motivating your staff. This is people management. As a
program manager you do this by interacting with your staff
Exercise 1 : Undertake a SWOT analysis of RNTCP in your respective state/ district.
Managerial Styles
Some of the key people management issues faced by most TB program Managers are:
-
229
Managers need to manage the program as well as the people they work with.
Managerial style may change according to the situation and persons being dealt with
Managers have to adjust their style of managing depending upon the maturity level and
readiness of the sub-ordinates.
Strategic Planning
Organizing
Leading
Monitoring and Evaluation
1. Strategic Planning :
What is it ?
Strategic planning is a process used to build a plan about the most important goals your
program should achieve in the next few years . RNTCP makes Annual Action Plans
which includes all aspects of planning financial , program and manpower related
Why is it important ?
The planning process is important to make sure that the state responds to the changing
needs of its stakeholders and outside organizations and to make sure that everyone
knows what actions will lead to achievements they intend.
What is to be included ?
Strategic plans should include :
Goals for changes that will advance programs mission
Specific actions to achieve those goals in the defined time-frame
The priorities of those actions
A clear assignment of responsibility for carrying out those actions
230
231
Leadership styles
1. Autocratic Style
- Requires unquestioned authority
- Emphasizes structure and order
- Weakness : Can be abrasive when trust is not earned or when the issues or the
audience required another style
2. Participatory Style :
- Appropriate for consensus building
- Emphasizes creativity
- Requires setting authority aside
- Weakness : Can be time consuming
- Each participant has effective veto power
3. Collaborative style
- Appropriate for resolving conflicts
- Requires mutual respect and authority
- Emphasizes reasonable outcomes
- Weakness: Difficult to accomplish consistently
232
LEADER
MANAGER
Visionary
Planner, Organizer
Strategist
Controller
Politician/ Advocate
Supervisor
Campaigner
Monitor
Team Builder
Change agent
Status quo
Negative leadership
style attributes
You may be surprised that some leaders with autocratic styles have accomplished a great
deal, while some affable and completely democratic leaders have accomplished very little.
It is clear that different styles and approaches of leadership are necessary in specific
situations and with specific people this is the basic thinking behind situational leadership.
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If the situation, or environment changes dramatically and the team member is faced with a
large scale emergency e.g. 20 cases of dengue in a hospital, then in that situation the team
workers may have the knowledge but no experience or skill, and their motivation may be
variable. Thus the situation may demand a different leadership style. A similar example is
a nurse who has mastered the principles of Polio has special strategies for reaching
merginalised communities and run very successful mass vaccination campaigns. However
she may not have been introduced to the DOTS programme and so still relies on only
monthly patient visits. You will need to modify your leadership style from delegating when it
comes to EPI to a more directive style for providing her with the right leadership to improve
her TB control.
4. Monitoring and Evaluation
Management is not complete without ensuring that monitoring and evaluation systems
are in place. The program manager needs to develop systems for checking on the
work of their team members to ensure that the desired results are achieved and to set
the stage for continuous improvement.
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Communication Skills
Communication is a part of every function of management, including management of health
services. Good communication enhances managerial and leadership skills, as well as
personal and role effectiveness. It promotes transparency and harmony in the work
environment, leading to greater involvement of staff and effective team and partnership
building.
As a TB Program Manager, you will need to communicate with a variety of people both
within and outside the TB Program. This section deals with interpersonal communication
with your staff to ensure that the work is carried out effectively.
Communication is the flow (transmission and reception) of information, ideas, feelings,
attitudes and perceptions both verbally and non-verbally, between two or more parties.
It embodies attitudes, behavior, body language, style, method of presentation, quality of
listening and perceptions and interpretations
.
Communication involves at least two people a sender or source and a receiver .
Communication takes place for a purpose, is expressed as a message and sent through a
channel from the source to the receiver. The receiver picks up the message, interprets it
and then responds. Communication can be thought of as a process or flow; communication
problems occur when there are blocks in that flow.
Understanding can occur only in receivers mind . A person may be listening, but not
necessarily understanding what may be said. Many managers overlook this fact when
giving instructions or explanations. They think that telling someone is sufficient. However
communication is only truly successful when the message is also properly interpreted and
understood. As per the figure
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Training courses: These are held to update the knowledge and skills of staff.
Lectures or seminars: These are held to introduce and explain new concepts,
procedures etc.
Interpersonal Channels
Managers often communicate orally with staff members on one-on one basis, to discuss
good or poor performance to motivate and counsel them, to discuss and solve problems
arising at the workplace and to better understand the individual problems of the staff.
Written communication: should be precise, clear, unambiguous , and to the point to avoid
any kind of confusion. The feedback on written communication is rarely instant, in fact there
may be long delays in seeking clarifications.
In general, the language used must lend itself to easy comprehension and spoken or
written in a manner that reflects an understanding of sensitivities of the receiver.
Email Communication: When communication is sent through email , you must be very
careful to check , who else is the message copied to , in order to avoid embarrassment or
breach of confidentiality.
Oral Communication : To use this medium effectively , it is important that the talk is brief ,
or only as long as the need be and is prepared and structured in advance to include all the
points that must be said.
Barriers to Communication
The process of communication can be very complex with its various elements and
variables. There are a number of barriers that impede effective communication They can
come up at the level of the sender, the message, the channels of communication or the
receiver.
Communication barriers at Organization level
Physical Distance
An important barrier to effective communication, particularly in large organizations is the
distance between people, making messages difficult to send or receive, or misinterpreted.
Organizational Policy and Culture
Organizational Policy and climate also determine in what manner an employee is expected
to communicate. Staff at lower levels within the system may not communicate easily with
staff at higher levels and vice versa.
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Team Building
As a TB Program manager one of your primary responsibilities is to develop an
effective team that works towards achieving the program goals. In your role as a
State TB Officer , you facilitate, motivate, and guide your team. You have to
transform a group of individuals into a team, by clarifying objectives, planning
operations with consensus, co-ordinating resources and getting things done
together, despite obstacles, stress and demanding pressures.
What is a team?
The term team is defined as a group of individuals working together for a common
purpose and goal with interdependent skills.
Four characteristics of a team
a) Team members must have a common goal and a reason to work together
b) Team members must perceive the need for an interdependent working
relationship
c) Individuals must be committed to the teams efforts and
d) The team must be accountable to a higher level in the organization
Teams are different from groups. A group is a collection of individuals who may not have
any of the four elements mentioned above. A team has the potential to accomplish much
more than the most efficient working groups that do not work as a team. A team leader
usually has a team leader who is responsible for what the team does as a whole and for
who does what within the team to achieve the objectives. The team leader is also a team
member.
As a TB Control Program team leader, you need to have the knowledge, skills and
capability to build a team as well as ensure that the team works together to achieve a
common goal. You would also need to adopt a managerial style that helps your team to
work more efficiently.
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Build a Team
Team building and development are important for several reasons
i.
ii. Stress among team members is reduced as problems are solved through sharing of
workload
iii. More innovative and creative ideas are generated, this improves team performance.
iv. Teams can solve complex, multi-interdisciplinary and interpersonal problems more
effectively than a group of individuals.
It is important for you as a manager to build an effective team in which various players (your
staff) work harmoniously together with an understanding of each others position, role, tasks
and capabilities. You as a manager need to focus on the following:
a.
b.
c.
d.
You would also need to adopt a managerial style that helps your team to work more
effectively and efficiently
The success of a team is dependent on a common understanding among members of the
team of their roles and responsibilities. The team members should be clear on:
a. what their job is and how it relates to the work of others in the team
b. the work and duties of all team members. This is to avoid duplication,
overlooking of key tasks, or one person taking on too much.
c. how each ones role relates to the teams goals
As a Program Manager, you have to build your team which has complementary skills . This
will help you in achieving the objectives through your people
A team has the potential to achieve much more than a group of talented individuals not
working as a team
As a State TB Program Manager , your ability to build and lead a team is crucial to the
success of the program in your state
Building Partnerships
As a TB control Program Manager, you are aware that effective TB Control services can no
longer be a function of the public health system alone. Experience with planning
National TB Programs has led to the recognition that the public health sector alone cannot
meet the requirements posed by increasing case loads , while simultaneously tackling all
the cultural , social and economic factors that influence TB as a disease. For effective
implementation of DOTS Strategy and in order to increase the reach and application of
DOTS, it has become clear that it is necessary to identify and reach out to all the health
care providers in both public and private sectors and further to all stakeholders in the nonhealth sectors.
It is essential that patients, their families and communities are also included in the fight
against TB.
Partnership Mutuality
Partnerships among individuals and groups have four overlapping characteristics that
benefit all parties concerned:
Networking to share information
Co-operating to provide resources to each other for achieving common goals
Working collaboratively as individuals or teams towards these common goals
Joining forces as partners in a common mission to help one another, e.g. Private
Practitioners may help a TB clinic to conduct its activities. This is referred to as
partnership mutuality.
The TB Program is such where inter-sectoral partnerships could prove extremely useful in
program implementation as well as in policy making, planning, program evaluation,
advocacy and generating additional resources.
The following are the key aspects that characterize a partnership with the potential to build
a long term relationship:
A vision is a realistic idea that is desirable for the program and its members and can be
achieved through joint efforts. Commitment refers to contributing something of value such
as time, money, resources or moral support
There should be a common vision to which all partners are committed
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Super-ordination
An overall goal is important to all partners concerned, and should be one that one entity
working alone could not achieve. The goal should be seen as a shared goal that all persons
or partners concerned should be seen to benefit from.
Everyone should gain
Building partnerships is based on recognizing the strength of each partner , accepting and
appreciating contributions made by each and making the most of each others contributions.
The strength of one will be recognized by the other
Eventually, the program and its member partners need to develop by taking personal
responsibility for both successes and failures
In both success and failure , all partners will be responsible
Openness is required for exchanging feelings, receiving and giving ideas , feedback and
constructive criticism
There should be open and frequent dialogue among partners
As a TB Program Manager , you should be aware of the strength of partnership and the
benefits that it can bring to program success
The concept of partnership mutuality (making sure that everyone benefits ) will help in
building strengthening and sustaining good partnership
FEEDBACK
Communication of information about an aspect of performance or behavior and its effects.
One of the key processes in managing performance of program staff is feedback. Many use
it as just a word in ordinary English language. In the context of managing staff performance
it is one of the most important and critical activities in the cycle of Performance
Management.
Giving feedback is as much an art as it is a science .Below are some of the key aspects of
feedback that will bring clarity to the whole concept and application of feedback that all
program managers must remember
Types of Feedback
Positive Feedback
Emphasize strengths
Mention areas of development
Be sincere
We should increase the personal effectiveness of our staff through appropriate feedback
and sharing.
Feedback should be a continuous process . there should be no surprises for the staff
member.
In a nutshell:
Be specific
Be constructive
Listen carefully
Ask questions to clarify disagreements or comments
Evaluate what is being said
Do not over-react to feedback, but you may wish to modify your behavior in
suggested directions and then evaluate the outcomes.
Deal informally with minor problems , through constant feedback , monitoring and
support
Arrange a meeting collate the facts and remain objective
Allow plenty of time for the individual to state their point of view
Options to deal with this problem for program managers
Set short term well defined objectives
Development interventions
Re-organize the job responsibilities
Agree corrective action and review periods
Keep a record / make note of discussions
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