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Evaluation of revised national tuberculosis control program, district Kangra, Himachal Pradesh, India, 2007

Background: The present evaluation study has been conducted with the following objectives: (i) To assess the treatment outcomes of revised national tuberculosis control program (RNTCP) in five microscopic centers of Kangra district under five tuberculosis units and (ii) To identify gaps and underlying contributing factors. Based upon the findings of (i) and (ii) we suggest appropriate measures to narrow down the existing gaps. Materials and Methods: We identified and interviewed health personnel involved, reviewed the documents and records pertaining to evaluation plan/guidelines, training records and reports generated by five tuberculosis units. We assessed the inputs, processes and outputs of the program across five tuberculosis units. We calculated the proportion of staff of various categories trained and internal quality control (case detection); availability of drugs, directly observed treatment short course (DOTS) providers, and supervision (case management) and information, education and communication (IEC), and funds distribution. (logic model). Result: Around 60%-88% of staffs of various categories trained with overall 25% gap of supervisory visits. In tuberculosis unit (TU) Nurpur, the discordant slides while cross-checking were 8% and 25%. The total proportions of sputum positivity are 5.1%; the highest in Kangra, i.e., 2.3% (national norms of 10-15%.). There was no full cross-checking of the positive slides despite internal quality in place. Increased numbers of the extra pulmonary tuberculosis cases (EPTB) are present in all TUs, as high as 61% in TU Dharamshala (Normal range 15%-20%). A gap of 20% DOT center exists-the least in (58%) in TU Nurpur. The awareness level in the TU Dehra is minimum (51%); more so in females and rural set up. Conclusion: RNTCP has successfully achieved all its targets in all the five TUs of Kangra District as per national norms despite several gaps. We recommend (i) filling of vacancies of medics and paramedics with reorientation trainings/refresher courses; (ii) conduction of supportive supervision by the seniors; (iii) investigation of cause of increased number of the extra pulmonary cases, and (iv) need of aggressive IEC activities.