Tuberculosis Control in India-current Problems and Possible Solutions

Attempts to reduce the problem of tuberculosis through organised efforts had their beginnings in India in the late thirties. With the introduction of chemotherapy, organised home treatment of tuberculosis from the TB clinics, situated mainly in cities and district headquarter towns, was started. The mass BCG campaign, started in 1951, gave the first indications that the problem of tuberculosis in rural areas could be as big as that in the urban areas. The need for extending case-finding and treatment of tuberculosis to the rural areas, in addition to urban areas, was confirmed by the sample survey (1) of tuberculosis conducted by the I.C.M.R. The concept of offering tuberculosis services as a component of the comprehensive health care delivered by the general health services was evolved in the country over two decades ago. The concept has been endorsed by the WHO (2) (3) and recommended for application in its member countries in accordance with the developmental situation in each country. In evolving this concept, cognisance was taken not only of the size and extent of the problem of tuberculosis but also of the fact that the rural areas continue to remain ill served. In the words of Morley (4) “Although three quarters of the population in most developing countries live in rural areas, three quarters of the spending on the medical care is in urban areas, where three quarters of doctors live. Three quarters of the deaths are caused by conditions that can be prevented at low cost, but three quarters of the medical budget is spent on curative services, many of them provided for the elite at high cost”.