Performance of Revised National Tuberculosis Control Programme (RNTCP) in tribal areas in India

Background & objectives: The Revised National Tuberculosis Control Programme (RNTCP) provides free diagnostic and treatment services to all tuberculosis (TB) patients registered under it. Equitable access, implying a preference for the most hard-to-reach groups particularly for tribal areas, is a major concern for RNTCP. This study was conducted to assess the performance of RNTCP in terms of case detection and cure rates in areas dominated by tribal groups in India. Methods: We used the RNTCP data collected by the Central TB Divison, Government of India. RNTCP has a systematic monitoring mechanism which tracks the outcome of every patient put on treatment. There is a standardized recording and reporting structure in place; indicators are monitored regularly at every level of the health system; and regular supervision ensures quality of the Programme. The main indicators include the number of cases diagnosed and the percentage of patients who are successfully treated. These indicators were used to assess the RNTCP performance in tribal areas. Results: We observed a poor performance in terms of case detection rate (CDR) in tribal and backward districts as compared with other districts in India. Among tribal districts 53 per cent in 2010, 45 per cent in 2011 and 56 per cent in 2012 had CDR of new smear positive < 70%. It was also observed that 26 per cent of tribal dominated districts had CDR of < 51 per cent in 2012. More than 50 per cent of tribal districts were not able to achieve more than 85 per cent of cure rate. Interpretation & conclusions: The findings of this study suggested that the overall RNTCP performance in tribal areas was not optimal, and the target of > 85 per cent of core rate was achieved by less than half of the tribal districts.