The Telegraph
Since 1st March, 1999
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Total detection rate and detection rate of smear positive cases were far below the expected level of 135 and 50 respectively from 1998 onwards. Default rate was also high in 1999. Conversion rate also decreased from 1999 onwards. Though the rate of cure was at the expected level, poor detection rate indicated that the programme could not cover all of the targeted population. In the 2 test-checked districts, the default rate was always higher, and achievement in the remaining components were much less than the expected level. The number of relapse cases increased from 140 in 1999 to 218 in 2000 in 2 test-checked districts. Cure rate of relapse cases was 62 per cent whereas default rate was 16 per cent in case of new smear positive cases in 1999.

As seen during audit, poor implementation and monitoring viz. non-investigation of all suspects/symptomatic for tuberculosis, deficiencies and shortfall in sputum microscopy, absence of health education, non-observance of dose medication, poor health service, non-utilization of the laboratory technicians, shortage of staff and inadequate monitoring/supervision were the main reasons for such poor performance though adequate funds and medicines were available.

As per guidelines prescribed by NTI, SCC drugs like Capsule Rifampicin (450 mg) and Tablet Pyrazinamide (500 mg) should be given under Regimen A of SCC (treatment under Regimen B not being rendered) to smear positive and seriously ill extra-pulmonary TB cases during the intensive phase of 60 days in the ratio of 1:3. However, during 1996-2001 the norm was not followed by chief medical officer of health/deputy director of health services (equipment and stores) in the 5 test-checked districts and central medical stores respectively.

While 96.97 lakh Tablet Pyrazinamide (average cost Rs 1.65 each) needed 32.32 lakh capsule Rifampicin (average cost Rs 3.64 each) 146.20 lakh capsules were procured by them in defiance of the guidelines, resulting in procurement of 113.88 lakh excess capsules valued at Rs 4.15 crore during 1996-2001. In the central medical store, the excess procurement was for Rs 2.14 crore (83.92 lakh purchased against 25.21 lakh required) while in the districts it amounted to Rs 2.01 crore (62.28 lakh for 7.11 lakh required). The reasons for the purchase of such excess quantity of Capsule Rifampicin were not stated by concerned DDOs. The matter calls for investigation.

The government of India released cash assistance only for the purchase of non-SCC drugs, required for sputum negative cases, in non-RNTCP districts. In 25 cases the deputy director of health services (equipment and stores) of central medical stores, Calcutta, procured SCC drugs valued at Rs 2.34 crore during 1998-2000, though not permissible. Of this, medicines worth Rs 1.18 crore were issued to 7 non-SCC districts in violation of guidelines. ADHS (TB) did not review the procurement periodically. The deputy director could not state how the requirement of the SCC drugs was assessed and purchased. In the sanctions issued by the PHP branch of health and family welfare department in March 1999, drugs to be purchased were not indicated though the GOI instruction was received in February 1999.

Further, chief medical officer of health, Birbhum, purchased SCC drugs for Rs 0.76 crore during 1996-2001 irregularly though the district was a non-SCC one and was not authorized to render treatment with drugs like Capsule Rifampicin and Tablet Pyrazinamide. SCC drugs valued Rs 1.12 crore were also stated to have been consumed in the above non-SCC district, genuineness of which was not evident. In the process huge funds were wasted by senior officers of the department which calls for investigation.

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