| Battle it out
In the Manickchak tuberculosis unit of Malda district five patients were declared cured by the medical officer without examination of sputum at the completion of treatment. Again sputum negative cases were put on treatment under Category II meant for re-treatment (sputum positive relapsed cases) and not under Category-III (patients with negative smear) as required. A smear positive patient who had completed treatment and had not got his sputum examined at the end of treatment was declared as cured.
(e) Fictitious issue of medicines: as per guidelines of the National Tuberculosis Institute, capsule Rifampicin-450 mg and tablet Pyrazinamide-500 mg should be given to smear positive cases at the ratio of 1:3 daily for a period of 60 days (intensive phase) under short course regimen. In Bolpur subdivisional hospital no treatment card/TB patient register was maintained. However, as per laboratory records 428 TB cases... were detected. For 3 positive cases, 4.87 lakh capsule Rifampicin-450mg and 0.56 lakh tablet Pyrazinamide-500 mg were reportedly issued by the hospital authorities instead of 180 capsules and 540 tablets respectively. In addition, 0.91 lakh injection Streptomycine, though not admissible under the above short course regimen A, were also shown as issued by the hospital. Genuineness of issue of so much excess medicine valued at Rs 22.95 lakh was doubtful and the matter calls for investigation.
Further, drugs were reportedly issued beyond the intensive period of 60 days by the units even up to 18 months in some cases... It was seen that the additional director of health services (TB) or assistant chief medical officers of health (public health and family welfare) did not issue National Tuberculosis Institute guidelines.
In Darjeeling district issue of excess capsule amounted to Rs 31.45 lakh. Such excessive issue of capsule Rifampicin had no valid reason and the possibility of these issues being fictitious cannot be ruled out. This involved excess expenditure of Rs 3.13 crore...In 4 test-checked districts (Birbhum, Bardhaman, Malda and Darjeeling), of 3.56 lakh patients, 30,993 patients (9 per cent) were given complete treatment at Rs 9.86 crore. Thus, for each patient, Rs 2,119 was spent (cost of drugs only) against prescribed norm of Rs 392.65 while 0.50 lakh (14 per cent) patients received partial treatment rendering the expenditure of Rs 1.39 crore unfruitful.
Use of medicine without sputum examination: in 4 test-checked districts (Bardhaman, Birbhum, Darjeeling and Malda) short course chemotherapy drugs were given by the attending physicians even to patients with negative smear and without examination of sputum to detect the cases as positive or negative.
In Asansol sub-divisional hospital, where sputum examination was never done, capsule Rifampicin and tablet Pyrazinamide were issued by the attending MOs to the extent of 2.26 lakh (Rs 8.24 lakh) and 2.29 lakh (Rs 3.77 lakh) respectively to 23,988 patients during 1996-2001.
Periodical review of treatment not conducted by MOs: as per guidelines of NTI, patients treated under standard regimen are required to be reviewed by the attending physicians after 6 and 12 months and those under short course regimen, after 3 and 6 months from the initiation of treatment. In the test-checked districts, the efficacy of treatment of the patients was never reviewed by the MOs for follow up treatment. As the treatment cards/TB patient register showing the date of starting treatment, particulars of anti-TB drugs issued, etc were not maintained by the units, no periodical review was conducted.
...Performance in implementation of Revised National Tuberculosis Control Programme (phase III) in 8 districts, including 3 pilot projects at Tangra Ward of Calcutta municipality (1994), Sagardighi block of Murshidabad district (1994 Phase-I) and Chandannagar Sub-Division of Hooghly district (1995-Phase-II) were as under:
In Howrah and Malda RNTCP was operative from the first quarter of 1999 and 0.11 lakh patients stood registered during 1999 and 2000.