TB control supervision will suffer, say officials manning the programme
On March 7 this year the Union health ministry ordered the merger of the Revised National TB Control Programme (RNTCP) and the National Rural Health Mission (NRHM). The justification given was that pruning the number of schemes by merging them will improve efficiency. The move has generated mixed response from within the government. People working under RNTCP say that supervision of TB control will suffer because of Centralisation and that monetary problems faced by the RNTCP staff will also increase manifold.
Till 2012, the Union budget allocated separate funds for TB which were distributed through NRHM, but the management was in hands of RNTCP officials. Salaries of the staff were also decided independently. In the current Budget, the money will be allotted by state NRHM directly. This will lead to managerial and structural changes. So far the state TB officer was responsible for supervision and distribution of funds; now it will be under the state mission director. The discussion on the merger has been on for many years. But the latest letter directing the change to be effective from April 1, 2013, has sent panic waves among those who oppose the move.
RNTCP was launched across the country in 1996 to control pulmonary tuberculosis. The need for a separate programme was felt because of the unique nature of the disease. TB is virtually curable for all patients, but only if the full course of medicines is taken regularly and completed, which takes about six months. Patients have the tendency to stop medication as soon as they start feeling better within one to two months of starting the course, creating the added trouble of drug resistance. Thus, a task force which can supervise the patients on an individual basis was deemed necessary.
The merger of the programme with NRHM has caused unease among people who believe that the system worked well.
"RNTCP model has produced good results. TB rate has come down in the country. Dismantling of the existing order will be harmful for the patients," says R M Tripathi, president of All India TB Employees Association.
Under the existing arrangement, decisions are taken by RNTCP officials. But now it will be managed by NRHM officials who have to perform many other tasks. As NRHM is run by state ministries, uniformity in RNTCP decision-making will be affected, say doctors and activists.
"We might see it working well in one state, but not in the other due to different political considerations," said a researcher from the National Institute for Research In Tuberculosis who did not want to be named.
A recent order of the Delhi government exemplifies the structural changes that may be brought in. RNTCP is being implemented through 26 chest clinics, each with the status of district TB centre, with decentralised monitoring and supervision. Under the new rules they will be combined, giving rise to nine main centres with one District TB Officer each.
"Thus, the strength of the monitoring officers will reduce from 26 to nine, which will have adverse effect on supervision,” says Tripathi. He adds the salary structures will also undergo changes with effect from April 1. The salaries will differ from state to state, creating frustration among staff of lower paid ones.
"The state NRHM will decide salaries, too. NRHM is known for scams and not paying its employees on time. The merger will result in the same for RNTCP workers too," he adds.
A health ministry official said that the decision has been taken to ensure that monitoring is done in a Centralised fashion in which balance between different schemes can be maintained.
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