Why tuberculosis control programmes fail? Role of microlevel and macrolevel factors: an analysis from India.
- 1 Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- 2 Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
- Correspondence to Dr Sudip Bhattacharya,
- Accepted 23 March 2017
- Published 21 April 2017
India accounts for one-fourth of the global tuberculosis (TB) burden. The National TB Program was started in 1962. Over a period of time, some lacunae such as poor case detection rate and incomplete treatment were observed. Later, the government formulated the Revised National Tuberculosis Control Program (RNTCP), which achieved a case detection rate of 70% and a cure rate of 85%. Still, the problem of relapse and defaulter cases persists. In 2014, 6% defaulter cases were reported from India. RNTCP has also focused on microlevel aspects, that is, newer diagnostics such as GenXpert, line probe assay and medicines such as bedaquiline for drug-resistant TB. Action on the macrolevel aspects, for example, social determinants, is ignored. This is natural because these are out of the purview of the health sector. This case study reflects how a resident doctor in a rural clinic of North India tried to resolve the macrolevel and microlevel issues pertaining to defaulter TB cases.
- Drugs and medicines
- Primary Care
- Healthcare improvement and patient safety
- TB and other respiratory infections
- Infectious diseases
Contributors SB and AS: Conception and design, acquisition of data or analysis and interpretation of data. SB and AS: Drafting the article or revising it critically for important intellectual content. SB and AS: Final approval of the version published. SB and AS: Agreement to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.
Competing interests None declared.
Patient consent Obtained.