CONTROVERSIES WITH INDIAN DOTS

CONTROVERSIES WITHIN INDIAN DOTS

India’s Revised National TB Control Program (RNTCP) or DOTS is virtually a paradigm shift from the past. Several of its features are simply unprecedented.

There is absolutely no doubt that at least three of its features of are par excellence:

  1. Generational switch in chemotherapy.Read More !
  2. Maintaining patient-wise boxes.Read More !
  3. Its concept of ‘close supervision’ of each patient till treatment is complete.Read More !

However, the program is still in its infancy; it has yet to pass the ultimate test – the test of time.

Some new radical features of this TB program have given rise to new controversies as follows:

1.      Omission of chest X-ray from the diagnostic menu of infectious lung cases; and also from the follow up of all lung cases.Read More !

2.      Near total dependence on a single test namely sputum smear test; even for follow up of sputum negative TB.Read More !

3.      Exclusion of TB expert from the program.Read More !

4.      Thrice-weekly instead of the traditional, time tested ‘Daily regime’ – and that too within a setting with unreliable supervision.Read More !

5.      Unreliability of program cure rates of 85% and health data in general released by government sector of India.Read More !

6.      Discrimination against certain groups of TB patients.Read More !

7.      Is the program futuristic? Is the design suitably adapted to the booming economy, status and capacity of India? Read More !

8.      Little consensus amongst Indian medical fraternity on some new program features.

9.      Non-inclusion of mammoth private sector (that caters to half the TB case load) in initial 10 years of the new program.Read More !

10.    Does the program stand well shielded from the omnipresent menace of sub-standard and spurious drugs?Read More !

11.    Fiscal prudence.Read More !

12.    Some other controversies.Read More !

13.   Black TB v/s White TB: Are Indian guidelines acceptable universally?Read More !

14.    Violation of human rights: Several measures like omission of X-ray and adoption of ‘Thrice-weekly’ instead of time tested ‘Daily regime’ were probably accepted in order to cut costs. Isn’t every human life equal and precious? Shouldn’t issues of human life transcend minor financial considerations and expediency?

Pros and cons of each controversy have been comprehensively discussed in ‘Detailed Study’ on India’s TB Control / DOTS (which is based on Author’s book The Test Of Time) and filed by Dr. Raman Kakar in Delhi High Court in a Public Interest Litigation (CWP (C) No.185 of 2007). Excerpts (often edited) have been suitably placed hereby in this Chapter as well as in another chapter namely “Overview – India” as on the home page