Professional Documents
Culture Documents
• Supervised treatment to ensure the right treatment, given in the right way. The
RNTCP uses the best anti-TB medications available. But unless treatment is
made convenient for patients, it will fail. This is why the heart of the DOTS
programme is "directly observed treatment" in which a health worker, or another
trained person who is not a family member, watches as the patient swallows the
anti-TB medicines in their presence.
• Systematic monitoring and accountability. The programme is accountable for the
outcome of every patient treated. This is done using standard recording and
reporting system, and the technique of ‘cohort analyses. The cure rate and other
key indicators are monitored at every level of the health system, and if any area
is not meeting expectations, supervision is intensified. The RNTCP shifts the
responsibility for cure from the patient to the health system.
The new Stop TB Strategy published by WHO in 2006 has DOTS in the core with
additional components to address TB/HIV and MDR-TB, health system strengthening,
involvement of all care providers, engaging people with TB and affected communities,
and enabling/promoting research. RNTCP is already implementing/ plans to implement
the activities recommended under the new Stop TB Strategy.
DOTS in India
The Revised National Tuberculosis Control Programme (RNTCP), based on the DOTS
strategy, began as a pilot in 1993 and was launched as a national programme in 1997.
Rapid RNTCP expansion began in late 1998. By the end of 2000, 30%of the country’s
population was covered, and by the end of 2002, 50%of the country’s population was
covered under the RNTCP. By the end of 2003, 778 million populations were covered,
and at the end of year 2004 the coverage reached to 997 million. By December 2005,
around 97% (about 1080 million) of the population had been covered, and the entire
country was covered under DOTS by 24th March 2006.
Every day in India, under the RNTCP, more than 15,000 suspects are being examined
for TB, free of charge. The diagnosis of these patients and the follow-up of patients on
treatment are achieved through the examination of more than 50,000 laboratory
specimens. As a result of these examinations, each day, about 3,500 patients are started
on treatment, stopping the spread of TB in the community. In order to achieve this, more
than 600,000 health care workers have been trained and more than 11,500 designated
laboratory Microscopy Centres have been upgraded and supplied with binocular
microscopes since the inception of the RNTCP. As a result of rapid expansion in
RAHUL GUPTA, MBAHCS (3RD SEM), SUBJECT CODE-MH0040, SET-2 Page 2
ASSIGNMENT ON HEALTH ADMINISTRATION
In 1992, the Government of India, together with the World Health Organization (WHO)
and Swedish International Development Agency (SIDA), reviewed the National TB
Programme and concluded that it suffered from managerial weakness, inadequate
funding, over-reliance on x-ray, non-standard treatment regimens, low rates of treatment
completion, and lack of systematic information on treatment outcomes. Programme
review showed that only 30% of patients were diagnosed and only 30% of those treated
successfully. Based on the findings and recommendations of the review in 1992, the
GOI evolved a revised strategy and launched the Revised National TB Control
Programme (RNTCP) in the country. Starting as pilots in October 1993, the RNTCP
was implemented in a population of 2.35 million in 5 sites in different states (Delhi,
Kerala, West Bengal, Maharashtra, and Gujarat). The programme was expanded to a
population of 13.85 million in 1995 and 16 million in 1996. Having proved both its
technical and operational feasibility, a soft loan of US $ 142 million was negotiated with
the World Bank in December 1996 and the credit agreement was signed with IDA in
May 1997. In 1997 RNTCP was launched as a national programme. It was envisaged to
implement RNTCP in 102 districts of the country covering a population of 271 million
in a phased manner. Another 203 SCC districts with a population of 447 million were
envisaged to be strengthened as a transitional step for introduction of revised strategy at
a later stage. Having started in 1997, rapid scale-up began in late 1998, when another
100 million populations was covered under RNTCP. Over the years RNTCP has
expanded rapidly as shown below:
March
Year 1998 1999 2000 2001 2002 2003 2004 2005
2006
Population
18 130 287 450 530 775 947 1080 1114
Covered *
* cumulative, in millions
Starting in 1997, the project was implemented in a phased manner to ensure that quality
of services is maintained. By March 2006, entire country has been covered under the
programme.
Revised National TB Control Programme and its recent progress in DOTS expansion
have been encouraging. As per Global TB Report 2003, 2/3rd of the additional sputum
positive cases reported under DOTS in 2001, were found in India. In 2002, over 620,000
cases were placed on treatment of which nearly 250,000 were new smear positive cases.
In the year 2003, more than 900,000 cases were placed on treatment. In the year 2004
alone more than 1100,000 cases were placed on treatment, and in the 2005, more than
1290,000 cases were placed on treatment - largest cohort of cases, more than any other
country in the world. By December 2009, more than 11 million patients have been
initiated on treatment, saving more than 2 million additional lives. The success of DOTS
in India has contributed substantially to the success of TB control in the world.
RNTCP has consistently achieved treatment success rate of more than 85%, and case
detection close to the global target. However, in 2007 RNTCP for the first time has
achieved the global target of 70% case detection while maintaining the treatment
success rate of more than 85%.
Primary
Intake Number of Primary multi-drug
District (Zone) isoniazid
period patients resistance %
resistance %
2.8
North Arcot
1999 282 23.4
(South)
f
Currently large scale representative drug resistance surveys are on-going in 2 States and
3 (Andhra Pradesh, Orissa, and Uttar Pradesh) other States are likely to conduct these
surveys.
RNTCP is planning to introduce second line anti-TB treatment for MDR-TB cases,
starting in early 2007. For this purpose State level Intermediate Reference Laboratories
are being established to provide quality assured culture and drug susceptibility testing
facilities. The guidelines for management of MDR-TB under DOTS-Plus strategy have
been developed.
In the first phase of RNTCP (1998-2005), the programme’s focus was on ensuring
expansion of quality DOTS services to the entire country. There are many challenges
remaining that are to be addressed in order to achieve the TB-related targets set by the
Millennium Development Goals for 2015 and to achieve TB control in the longer term.
The RNTCP has now entered its second phase in which the programme aims to firstly
consolidate the gains made to date, to widen services both in terms of activities and
access, and to sustain the achievements for decades to come in order to achieve ultimate
objective of TB control in the country.
All components of new Stop TB Strategy are incorporated in the second phase of
RNTCP. These are:
6. Enable and promote research for the development of new drugs, diagnostic and
vaccines. Operational Research will also be needed to improve programme
performance.
The Revised National TB Control Programme now aims to widen the scope for
providing standardized, good quality treatment and diagnostic services to all TB patients
in a patient-friendly environment, in which ever health care facility they seek treatment
from. Recognizing the need to reach to every TB patient in the country, the programme
has made special provisions to reach marginalized sections of the society, including
creating demand for services through specific advocacy, communication and social
mobilization activities.
The International Health Regulations 2005 are legally binding regulations (forming
international law) that aim to a) assist countries to work together to save lives and
livelihoods endangered by the spread of diseases and other health risks, and b) avoid
unnecessary interference with international trade and travel. The purpose and scope of
IHR 2005 are to prevent, protect against, control and provide a public health response to
the international spread of disease in ways that are commensurate with and restricted to
public health risks, and which avoid unnecessary interference with international traffic
and trade.
The Twenty-Sixth World Health Assembly in 1973 amended the IHR (1969) in relation
to provisions on cholera. In view of the global eradication of smallpox, the Thirty-fourth
World Health Assembly amended the IHR (1969) to exclude smallpox in the list of
notifiable diseases. During the Forty-Eighth World Health Assembly in 1995, WHO and
Member States agreed on the need to revise the IHR (1969). The revision of IHR (1969)
came about because of its inherent limitations, most notably:
• Narrow scope of Notifiable diseases (cholera, plague, yellow fever).[1] The past
few decades have seen the emergence and re-emergence of infectious diseases.
The emergence of “new” infectious agents Ebola Hemorrhagic Fever and the re-
emergence of cholera and plague in South America and India, respectively;
These challenges were placed against the backdrop of the increased travel and trade
characteristic of the 20th century. The IHR (2005) entered into force, generally, on 15
June 2007, and are currently binding on 194 countries (States Parties) across the globe,
including all 193 Member States of WHO.
1. With full respect for the dignity, human rights and fundamental freedom of
persons;
2. Guided by the Charter of the United Nations and the Constitution of the World
Health Organization;
3. Guided by the goal of their universal application for the protection of all people
of the world from the international spread of disease;
4. States have, in accordance with the Charter of the United Nations and the
principles of international law, the sovereign right to legislate and to implement
legislation in pursuance of their health policies. In doing so, they should uphold
the purpose of these Regulations. (Art 3. IHR (2005))
The Board meets at least twice a year; the main meeting is normally in January, with a
second shorter meeting in May, immediately after the
Health Assembly. The main functions of the Executive
Board are to give effect to the decisions and policies of the Health Assembly, to advise
it and generally to facilitate its work.
Comprising 36 members, representing the five regional groups of Member States at the
United Nations, the Executive Board reviews UNICEF activities and approves its
policies, country programmes and budgets. Its work is coordinated by the Bureau,
comprising the President and four Vice-Presidents, each officer representing one of the
five regional groups.
The Office of the Secretary of the Executive Board supports and services the Executive
Board. It is responsible for maintaining an effective relationship between the Executive
Board and the UNICEF secretariat.
The Executive Board’s annual term is identical to a calendar year, running from 1
January to 31 December. The Executive Board meets three times each year, in a first
regular session (January/February), annual session (May/June) and second regular
session (September). Executive Board sessions are held at the United Nations
headquarters in New York.
DICOM enables the integration of scanners, servers, workstations, printers, and network
hardware from multiple manufacturers into a picture archiving and communication
system (PACS). The different devices come with DICOM conformance statements
which clearly state the DICOM classes they support. DICOM has been widely adopted
by hospitals and is making inroads in smaller applications like dentists' and doctors'
offices.
DICOM differs from some, but not some other, data formats in that it groups
information into data sets. That means that a file of a chest X-Ray image, for example,
actually contains the patient ID within the file, so that the image can never be separated
from this information by mistake. This is similar to the way that image formats such as
JPEG can also have embedded tags to identify and otherwise describe the image.
A DICOM data object consists of a number of attributes, including items such as name,
ID, etc., and also one special attribute containing the image pixel data (i.e. logically, the
main object has no "header" as such - merely a list of attributes, including the pixel
data). A single DICOM object can only contain one attribute containing pixel data. For
many modalities, this corresponds to a single image. But note that the attribute may
contain multiple "frames", allowing storage of cine loops or other multi-frame data.
Another example is NM data, where an NM image by definition is a multi-dimensional
multi-frame image. In these cases three- or four-dimensional data can be encapsulated in
a single DICOM object. Pixel data can be compressed using a variety of standards,
including JPEG, JPEG Lossless, JPEG 2000, and Run-length encoding (RLE). LZW
(zip) compression can be used for the whole data set (not just the pixel data) but this is
rarely implemented.
DICOM uses three different Data Element encoding schemes. With Explicit Value
Representation (VR) Data Elements, for VRs that are not OB, OW, OF, SQ, UT, or UN,
the format for each Data Element is: GROUP (2 bytes) ELEMENT (2 bytes) VR (2
bytes) LengthInByte (2 bytes) Data (variable length). For the other Explicit Data
Elements or Implicit Data Elements, see section 7.1 of Part 5 of the DICOM Standard.
The same basic format is used for all applications, including network and file usage, but
when written to a file, usually a true "header" (containing copies of a few key attributes
and details of the application which wrote it) is added.
a. Impact on Health-
include: current income level, recent income change, poverty flags, current
earnings, multi-period averaged incomes, relative position in the income
distribution and number of spells of poverty. In summing up their review, the
authors conclude: .All of the studies that include measures of income level
find that it is significantly related to health outcomes.
Further important conclusions from this body of work include the following:
• The relationship between individual income and health is non-linear (i.e.
low-income individuals suffer larger negative health consequences than
high-income individuals reap health benefits, though high-income individuals
do reap benefits).
• Longer-term measures of average income have larger associations with
health than measures of current income, which can be highly volatile.
From the viewpoint of the conceptual issues addressed in the paper, it is important that
future research compile more elaborate data on health indicators. Thus, for example,
ASR in poor countries reflects the levels of nutrition, smoking prevalence rates,
infectious diseases, health infrastructure, and factors such as accidents leading to
premature deaths. By contrast, differences in ASR in middle and high income countries
may be strongly influenced by genetic factors and by the timeliness and costs of
preventive health care. Because investments in skill acquisition in poor countries depend
on the ASR, the years for which skilled labour remains productive is likely to be
important for explaining economic productivity.
RAHUL GUPTA, MBAHCS (3RD SEM), SUBJECT CODE-MH0040, SET-2 Page 11
ASSIGNMENT ON HEALTH ADMINISTRATION