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Our Experience-Involving Private Practitioners in TB case Notification

J Gupta, P Praseeja

A study is being undertaken in Tumkur district of Karnataka to estimate the incidence and period prevalence of tuberculosis (TB) by linking data from three sources namely, Revised National Tuberculosis Control Programme (RNTCP), Siddhartha Medical College and every private nursing homes in the district. At the outset, the requisite support and cooperation for the study team was sought from the state health authorities. Initially, the list of nursing homes in the district with the name of the Medical officer in charge, address and contact numbers were obtained from the District Tuberculosis Officer (DTO). All the PPs were appraised through official correspondence regarding the study objectives and the need for their involvement in TB case notification. At the first stage the private practitioners (PPs) hailing from the 43 nursing homes of Tumkur town were invited to attend the CME in the office of the DTO to sensitize them about the modalities of the study and also the programme management under RNTCP. DTO visited each nursing home and personally delivered the invitation. The CME was held between 3.00-5.00PM on 26th November 2011and necessary reference materials including refreshments were arranged by DTO. During the CME, talks were delivered on International Standards for TB Care (ISTC), RNTCP strategy in brief on diagnostic and treatment strategies and initiatives being undertaken for diagnosing and management of Multi-Drug Resistant (MDR) TB. This was followed by sensitization on ‘Capture-recapture study’ which requires all the private nursing homes to prospectively record and maintain the information regarding each TB case diagnosed by them. The information would be collected from the nursing homes by Senior Treatment Supervisor (STS) on a monthly basis as proposed by DTO and data will be passed on to NTI through DTO. However, only eight PPs could attend the CME, probably due to their hectic schedule. Thus a decision was taken that the officials of Epidemiology and Research Division, NTI may visit each nursing home and sensitizes each of the PPs personally. Accordingly, Every Medical officer in charge of the nursing homes in the district was sensitized individually about the study and RNTCP materials including ‘RNTCP Module for Private Practitioners’ in the form of hard and soft copies was given to each people during the visit.

The health visitors of District Tuberculosis Centre (DTC) accompanied the team for local guidance on many occasions. During the visits, IEC materials and films on TB were also demanded by some PPs to create awareness among the community. The district health authorities were informed regarding this issue and necessary materials were supplied. Subsequently, two more CMEs were conducted in Sri Raghavendra Nursing Home, Madhugiri and Swami Vivekananda Integrated Rural Health Centre, Pavagada (SVIRCH) on 8th February 2012 at 3.00PM and 8.00 PM respectively. Swami Japanandji, the in-charge of SVIRCH provided the necessary logistics and material support for the CME, including refreshments for the participants. About 80% of the PPs attended these meetings. Clarifications regarding RNTCP and other issues related to TB diagnosis and Treatment sought by the PPs were given. The remaining nursing homes were visited personally on the next day and their co-operation in maintaining the necessary data was sought. The printed and spiral bound registers for recording necessary data along with necessary guidelines have been provided to the in- charge of each nursing home.

It is heartening to note that all PPs welcomed the officials of the team from NTI and expressed their full support and very cooperation. They also agreed to provide the data to the STS and two Health Visitors on monthly basis. The STS and Health visitors have also been sensitized about the modalities of the study and their role. It is felt that the vital experiences learnt will also be useful in any future endeavour to involve the private sector in case notification.