India bears 21% of the global burden of incident TB cases and has the highest estimated incidence of Multi Drug Resistant-TB cases (MDR-TB) (131,000 out of global incidence of about 500,000 in 2007). Extensively Drug Resistant TB (XDR-TB) has also been reported from India. HIV prevalence among TB patients is reported to be 4.85%.

India’s Revised National Tuberculosis Control Programme (RNTCP), based on DOTS strategy, is being implemented through general health system of the states under the umbrella of National Rural Health mission (NRHM). The Programme is implementing all components of WHO Stop TB Strategy 2006 and has made great strides in achieving global targets for new smear positive case detection (NSP CDR) (70%) and treatment success (85%), as per the Millennium Development Goals (MDGs) and the related Stop TB Partnership’s Global Plan (2006-2015). The programme needs to now consolidate and sustain current achievements uniformly across all states and districts in the country, and to increase access to quality TB care for all, including DR-TB. However to achieve these goals, the programme faces certain challenges.

This proposal intends to address the identified challenges like insufficient laboratory capacity for detecting and follow up of requisite drug resistance cases in the country and funding gaps for procurement of second line drugs for all MDR-TB cases planned to be initiated on treatment. Though the programme is achieving targets of NSP CDR and treatment success at national level, wide variation in performance is observed across districts in form of low case notification rates, high treatment default rates, and areas with vulnerable populations or health systems access challenges. Further, the programme has a well defined ACSM strategy and continuous efforts are being made in building the capacity of the states for need based planning of ACSM activities. There are also approved schemes for the involvement of NGOs and Private Practitioners. However there is sub-optimal capacity in state and districts to execute and monitor such activities leading to poor community involvement and limited engagement of all health care providers including NGOs, corporate sector and private practitioners in the TB programme.

Addressing these challenges requires a concerted response from the government and civil society, this being the overall strategy of the GF Rd 9 proposal having three Principal Recipients viz Central TB Division (CTD) (Government of India - GoI), and a partnership of 16 NGOs organised under 2 civil society PRs (the International Union Against Tuberculosis and Lung Disease, or ‘the Union’, and World Vision India). In addition to being aligned with the national strategy and the WHO Stop TB Strategy, the proposal addresses several recommendations from the Joint Monitoring Mission (JMM) 2009, review by World Bank experts, and other stakeholders in TB Care and Control in India.

Decrease morbidity and mortality due to drug resistant TB (DR-TB) in India and improve access to quality TB care and control services through enhanced civil society participation

1. Establish and enhance capacity for quality assured rapid diagnosis of DR-TB in 43 Culture and DST laboratories in India by 2015 (PR – CTD; Scope – national)

2. Scale-up care and management of DR-TB in 35 states/Union Territories of India resulting in the initiation of treatment of 55,350 additional cases of Drug Resistant TB (DR-TB) by 2015. (PR – CTD; Scope – national)

3. Improve the reach, visibility and effectiveness of RNTCP through civil society support in 374 districts across 23 states by 2015 (Civil society PRs)

4. Engage communities and community-based care providers in 374 districts across 23 states by 2015 to improve TB care and control, especially for marginalized and vulnerable populations including TB-HIV patients (Civil society PRs)

By the end of December 2009, against a target of 16000, 15903 persons were provided with the OPD services. Out of the total cases accessed to the base hospital OPD, among them 8612, 5693, 899 and 699 are respectively adult male, adult female, male child and female child. The percentage of women is 36% and the percentage of women & children is 46%. The access of women and children has been reduced in comparison with the last year’s achievement of 53.38%. 5955 persons have accessed the OPD for review and out of them 47% are women and children.

In 2009, the project conducted 4,559 numbers of the adult cataract IOL surgeries (95%) against the target of 4,800 and 48.16% of women cases were benefited out of the total adults benefited from the cataract IOL surgeries. The project has performed 36 numbers of child IOL cataract surgeries against the annual target of 35 numbers.

The support restored the Childhood

Kumari Jyotsna sethi, 14 years old, daughter of Banamali sethi belongs from Rajanpali village of Boudh district. She is the only child of her parents and that is why she gets all the affection from her parents. She grows up with much love in the family. She studies in class 8th at Butupalli, High school of Boudh district.

Her father is a small farmer with one acre of agriculture land. The annual income is not sufficient to manage the family economy. However, with the income from his own agriculture land as well as labour work sometimes, her father manages the family and the education of Jyotshna.
Time passes and one day her mother observes that Jotshna is not able to tracing the things and domestic appliances properly and father also observes the same. School teachers complains that Jyotshna is not keeping any interest on study. Her father also observes the same. The school teacher says that she is not able to look at the black board and reading properly. Subsequently, friends and neighbours starts to address her as the blind Girl in the community. Gradually Jyotshna becomes depressed and stops going to play with her friends and avoids the gathering in the community. She also expresses her unwillingness for study. One of the neighbors observes a white spot on the right eye pupils. Her father contacts the local traditional healer for treatment who fails to recover the same through his treatment. The parents make lots of expenses for the treatment of Jyotshna. Then they takes Jyotshna to Boudh District Head Quarter Hospital for treatment. The doctor diagnoses her with immature cataract and asked them for contacting the Mahanadi Netra Chikitsalaya of Birmaharajpur of Sonepur district.
She comes to MNC 5th August 2009 and was admitted for cataract surgery. Her Uncle and Parents are counseled by the Ophthalmic Assistant for the surgery. The cataract surgery is conducted on her right eye on the same day through phaco with the intra ocular lens (IOL) in free of cost. Free spectacles and medicines are provided to her as per the prescription of the Ophthalmologist of the Mahanadi Netra Chikitsalaya of LEPRA Society. After the successful surgery, her parents express their happiness and gratitude to LEPRA Society as well as the person or institution who provides support for this noble work. Jyotshna is now very happy she becomes able to see. Now she has got back her earlier life stile i.e. in relation to continuing her study, playing with friends and joining the community gathering.

The support could provide relief in old age by restoring the vision

However, she gets the oldage pension which is Rs. 200/- (Rupees Two Hundred only) per month. Suddenly, she feels vision problem which increases gradually. She becomes unable to see and work properly. Cooking for herself and earning for herself becomes difficult. As her daughter are in their in-laws’ house, there is no scope of getting support from them. In the course of time, Basanti loses his complete vision. She could know about the community eye screening camp of Mahanadi Netra Chikitsalaya of LEPRA Society at Tarava. She requests her elder son-in-law to guide her to the screening camp. Basanti attends the screening camp and diagnosed with matured cataracts. She is brought to the Mahanadi Netra Chikitsalay by the project outreach bus on 13th August 2009 and was registered for cataract surgery. On 14th August 2009, her right eye is operated through the use of phaco and operating microscope and IOL is implanted. The surgery becomes successful and Basanti gets back her vision in the right eye. After seven days of her surgery, her vision is tested and found with very good vision. She also expresses her happiness as she is able to see the things and do her daily activities independently. She is waiting eagerly for the surgery in her left eye.

Restoration of Childhood

Sumanta Beriha,7/M of C/O Bhagban Beriha, hails from Jatasingh village of Boudh District. He is the youngest son of his parents with three brothers and only one sister. Being the youngest son of his parents Sumanta is being loved by everybody in the family. His elder brother was having eye diseases which led him to incurable blindness. Sumanta was all of sudden lost his vision at the age only 4 years. His father is a farmer and also works as a labourer. The mother is a house wife and sometimes works as labourer. When Sumanta is admitted into the school, the irony that he is found to have very low vision in both of his eyes for which he faces lot of problems in reading and writing. Gradually Sumanta was pushed into more and more darkness. Sumant is not able to carry out independently the daily activities, reading and playing. Gradually he stopped school going, playing with friends. He loses his childhood. The parents have no money for the treatment of their beloved son and because of the same reason and ignorance their elder son becomes blind. They have to only cry and blame their lucks. The parents go to the District Head Quarter Hospital, Sonepur but, the treatment could not be possible as the hospital is not having facilities for children surgery.

In course of time, his uncle who is staying nearby MNC informs his parents to come to MNC for treatment. The parents come with the son on 7th February 2009 and Sumanta is registered bearing the MR No 47526/09. He is detected with congenital cataract in both his eyes. Parents and the uncle are counselled for the surgery. Sumanta is admitted on the same day. His right eye is being operated with Small Incision Cataract Surgery (SICS) with IOL on 8th February 2009. His vision is improved to 6/18 in his right eye.

Now, he is able to play, read and write and he is happier that his vision has again restored. His parents are too happy as the childhood of their beloved son is getting restored and have expressed their gratitude to MNC for great support to their child and family. After few days, his left eye will be operated.

Resources

Infrastructure: The hospital is housed in its own two storied building having a covered area of 5000 sq. ft.. MNC has accommodation for 30 beds, suitable surgical and therapeutic equipment are available for providing eye care. The hospital has a minibus for outreach activities and transportation of patients identified with cataract to the base hospital for surgical intervention.
Physicians/Staff: There are 30 full time/part time workers at the MNC hospital. These include one full time doctor, nurses, paramedical staff and non-clinical personnel. The physicians are well supported by a multitude of staff members such as nurses, refractionists and technicians who actively participate in the health care team
Work Times: The hospital works six days (Mon-Sat). Patients usually come at 9 a.m. and the work day ends at 5 p.m.
Food: Breakfast, lunch and dinner are also provided free of cost to the patients and their attendants. On an average food is provided to 30 numbers of people per day at MNC.