DISCRIMINATION INBUILT IN THE PROGRAM:
Since case detection relies primarily on sputum smear microscopy, the design favors the sputum positives and discriminates against the rest who, no doubt, are not spreading infection to others, but personally face equal risk. The stated target of DOTS is to detect 70% of the infectious cases and cure 85% of them. Obviously, the program primarily focuses on and discriminates in favor of the sputum positive cases at the expense of the rest. Besides, diagnosis of childhood and extra-pulmonary TB is a highly complex process. The original design of the DOTS pipeline, with its hastily trained plain MBBS doctors, absolutely unsupervised by experts, poses a risky option for a large section of patients that includes kids, extra-pulmonary cases, and also HIV +ve, pregnant, diabetic, on-steroid or suspected MDR cases.