Medical College Task Force Workshop on NTEP

1. Date:
Dr Sanjay Suryawanshi
WHO National Consultant,
(Medical Colleges Support & Institutional strengthening)
Central TB Division, MoHFW, New Delhi -110001
• Email: suryawanshis@rntcp.org ; 98960370714; 9890170711
National Workshop for Medical Colleges Task Force to
Accelerate Ending TB in India
Formation, functions, meeting template for medical college core committee

2. •Background
•Need to involve medical colleges in NTEP?
•Core committee and its formation
•Functions of Core Committee
• Patient flow- OPD/IPD
• Contribution of medical colleges
•Records /reports
•Challenges
Contents

3. Background (1)
• In India, a medical college is an educational institution that
provides medical education. The term is synonymous with "medical
school" as used in the US and some other countries.
• These institutions may vary from stand-alone colleges that train
doctors to conglomerates that offer training related in all aspects of
medical care.
• MBBS is a degree in medicine established by Indian Medical Council
Act 1956 and continued in National Medical Commission Act 2019.
• After MBBS, doctors register with state medical councils.
• BAMS Colleges in India:
273 BAMS colleges in India (Pvt- 223 BAMS; Govt 53)
• Dental Colleges in India:
324 ( Govt-57 , Pvt 267)
• 645 med colleges (NMC)

4. Background (2)
Medical Colleges India- 645 (as per NMC )
• Government Medical colleges are affiliated
with the Central Government or State
Government and are operated by them to
provide education to candidates at a low price.
• Private colleges are operated by individuals
or groups of individuals and are directed
towards making the most profit and fame.
• Come under the state university
• Deemed Medical college
• Deemed university
• Central medical college comes under Central
university by the central government, different
ministries eg Ministry of Labor, Defence
36, 6%
6, 1%
339, 52%
26, 4%
238, 37%
Type of collese as per NMC
Society Govt-Society Govt Pvt Trust
Type Number
Govt 339
Govt-Society 6
Society 36
Pvt 26
Trust 238
645

5. • Medical Colleges, being tertiary referral unit, does not have a limited geographical area to be
covered.
• Hence the patients are being referred to medical colleges from within the districts the
college is established and even from outside the districts and state
• There is huge potential for the detection of TB cases from TB and chest departments as well
as from the other departments too.
• Not only TB case detection but medical colleges can play an important role in advocating TB
and TB control programs amongst the UGs/PGs and medical faculties from medical colleges and
involved in operational research.
• The continuing success of NTEP requires the involvement of all large providers of care
including medical colleges because still TB patients continue to be treated outside NTEP with:
• X-rays as the primary means of diagnosis ;
• Non-supervised non-NTEP regimens.
• no system for tracking defaulters
Need to involve medical colleges in NTEP? (1)

6. • Mainstreaming Management of DR-TB-
- A novel opportunity to provide clinical expertise to the program,
- Efforts to establish specialized DRTB OPD/Pediatric DRTB Centers- active participation in treatment & care of
DRTB patients ( using standard regimen/designing regimen )
- Managing ADR of new drugs. (Dechallenge and Rechallenge of drugs)
- Counseling patients and family- Motivating patients to have regular follow-ups.
- Pulmonary rehabilitation-
- Palliative care components can also be explored.
• Many doctors are yet to be familiarized with NTEP - an ongoing activity under NTEP.
- 560/ 645 medical colleges ( as per NMC ) are participating in NTEP & still a significant number of medical colleges are yet to
implement NTEP ( ongoing ).
• The concept of the involvement of medical colleges was thought in the year 1996 and it was very well
shaped in the first CTD National Consensus Workshop/ conference - 1997. Series of workshops done
DURING
• 2001 : National workshop of medical college professors at NTI & AIIMS
• 2002 : Consensus workshops in States, medical colleges
• 2002 : National workshop at AIIMS: 7 nodal centers identified, processes & structure agreed upon- “Task Force Mechanism”
Need to involve medical colleges in NTEP? (2)

7. Zone
No of medical
colleges
No of
state
States in the Zone
Northeast 17 8
Meghalaya, Sikkim ,Arunachal
Pradesh, Assam, Tripura,
Mizoram, Manipur, Nagaland
East 79 5
Bihar, Jharkhand, Odissa,
Chhatisgarh, WB
West 137 6
Gujarat, MP, Maharashtra, Goa,
Rajasthan, D&NH and Diu and
Daman
South-1 109 3 Karnataka, Telengana, Andhra
South-2 102 5
Puducherry, Tamilnadu, Kerala,
Lakshadweep Andaman &
Nicobar
North 116 9
Punjab, Haryana, Chandigarh,
Jammu & Kashmir, UP, Delhi,
Uttarakhand, Ladakh, Himachal
Pradesh
560 (645) 36
Core Committee
( in each medical college)
Chairperson:
Director /Dean/Principal/Senior
Medical Superintendent
Nodal office ( Clinical ): Faculty from
Pulmonary Medicine/ General Medicine/
Clinical Department
Nodal office (Public Health ): Faculty
from Community Medicine
Members: HODs from ALL departments
/representation from Dental/BAMS
National Task Force
CTD WHO
Zonal Task Force
STO of each state
STF representative of each Medical
College of the state
State Task Force
STO of the state A representative from each medical college
Structure of Task Force
National Institutes
(NTI/NITRD/NIRT)
Medical
Colleges
Structure of Task Force

8. Training/
teaching
of NTEP
amongst
Engagement
with the
NTEP
Operational
Research
Advocacy of
the NTEP
• Formation of the Core Committee
• Establish TB diagnostic Centre &
Treatment Support Centre
(Microscopy & DOT centers) in all
medical colleges
• Strengthening of infrastructure
• C & DST Laboratories
• DRTBC-Nodal/Dist
• COE TB / COE pediatric TB
• Service delivery - Diagnosis/
treatment of TB (DSTB/ DRTB ) /TBI
• Ensure that the NTEP guidelines for
diagnosis/ treatment of TB are being
followed in medical colleges
• Programme to ensure
NTEP training in each
medical college with support
from medical college faculties
• Conducting periodic
training / Sensitization
workshops/ CMEs for
faculties/ PGs/ Interns /
Paramedical staff (LTs &
Nursing staff)
• Faculty members to ensure
cooperation and internal
referrals of all chests
symptomatic to be diagnosed
as TB and treated as per
NTEP
• Organize seminars/ conferences/
continuing medical education for
medical college faculty and private
sectors
• Sensitization/training through IMA,
other professional bodies, and their
members
• Involvement of MCI – NMC in the long
run emphasis is to give to the teaching of
TB as per NTEP guidelines by making it
mandatory for approved medical
colleges to train and include in teaching,
field, and practical teaching, examination
papers, etc
• Through the use of newsletters, press &
other media
• Operational
research
should be
directed on a
priority basis,
toward the
broader
objectives
Role of medical college

9. • It is a joint activity. Medical College and DTO of the district to initiate activities in medical colleges
• The committee will be constituted by the Principal/Dean/Director of the Institution /Medical college
• The committee will have one Chairperson and Two Nodal Officers who will perform both clinical & public health
activities.
• The Principal/ Dean/Director of the Medical Institution will notify the committee. Following will be the office
bearers & members of the committee:
• Chairman: : Principal/ Dean/ Director/ Senior Medical Superintendent*
• Member Secretary : Dist TB Officer of the district in which the Medical College is located.
• Nodal Officer (Clinical) : Faculty from Pulmonary Medicine/ General Medicine/ Clinical Dept
• Nodal Officer (Pub Health) : Faculty from Community Medicine
• Coordinator : Identified by the colleges
* Director of Medical Education/ DHS cannot be the chair of this committee.:
• Microbiology
• Pharmacology
• Psychiatry
• Pediatrics
• Ophthalmology
• Orthopedics
• Nursing Supt
• Medical Officer at DOT/
DRTB Centre
• Co-opt any members
committee feels (eg IMA)
• Medical Superintendent
• General Medicine
• Pulmonary Medicine
• Community Medicine
• OBGY
• Thoracic surgery
Members: All HODs of the related departments
• Dermatology
• ENT
• Pathology
• Biochemistry
• Rep-Dental/Ayurvedic colleges
Special invitees:
• STO/STF Chair
• /Chair state OR
Committee / WHO
Consultant/
Formation Medical College Core Committee (MCCC) (1)
Formation Medical College Core Committee (MCCC) (1)

10. • Since the post of Chairman and Member Secretary are ex-officio, there is no fixed tenure for the
same
• All other members including Nodal Officers ( Clinical and Public Health) and Coordinator & will have a
tenure of three (3) years.
• At the end of their respective tenure, new members will have to be replaced/ deputed from the same
department.
• No office bearers or members can hold the office after retirement/ resignation orif no longer
employed/associated with the same Medical College in any capacity..
• The Chairman/Nodal officers of MCCC should be willing to spare time for the cause of Task Force
activities
• Member Secretary with NTEP staff to coordinate NTEP activities in the colleges ( planning of CC
meetings, training, sensitization, logistics etc )
Formation Medical College Core Committee (MCCC) (2)- Terms and
reference
Formation Medical College Core Committee (MCCC) (2)- Terms and reference

11. Functions of Core Committee (1)
2. Coordination between
various departments
3 . Coordinate with the district
program ( DTO )
- NTEP staff to coordinate
4. Conduct Core Committee meeting
on a quarterly basis
(Analyze data - review performance )
5. Prepare and Submit a Quarterly
PHI report/ Medical College
report to the DTO
6. Training/sensitization of faculty /
PGs/ intern /staff ( Yearly Training
calendar to be prepared)
7. Ensure that teaching TB/ NTEP as a part of
the curriculum to UGs / PGs
10. Support District TB Officer in ACF/ ICF/
TB free dist /SNC
8. Undertake Operational Research &
facilitate the thesis in each department.
( use Priority areas, and guidelines
provided by the CTD )
9. Undertake advocacy for the programme
by publishing articles on TB, newsletters
1. Improve case notification with UDST /
HIV/DM testing;
• Referral (outdoor/ Indoor)
• Cross referral (TB-HIV/NCD/NRC)
• Linkages to NAAT/C DST Lab
• Maintain NTEP recording/reporting –
with Nikshy entry run through NTEP
Centre (TBDC/ TC )
• Assign one faculty as coordinator
Functions Core
Committee in medical
collages

12. Functions of Core Committee (2)- Improve case notification
(1) Patient Flow- At the OPD- ALL
• Presumptive TB patient (ALL) – identified, subjected to necessary investigations from ALL (OPD)
• To track the referrals, it is suggested to keep the referral register in each dept. This will help
in monitoring department-wise referrals.
• Further, this will be entered in Lab/NAAT register. Use NTEP formats (annex 15 A)
• Establish Linkages to TB diagnostic Centre /NAAT with a mechanism to refer presumptive TB
patient
• Intensified Case Finding - ANC/Diabetic clinic/ART Centre-ICTCs/
• Patient diagnosed as TB in all departments (OPD)
• DSTB - Initiate treatment with prescription
• DRTB - refer patients to DRTB center ( nodal/Dist level )
• ALL diagnosed TB patients are to be referred to an NTEP Treatment center placed in a
medical college. (Space to be identified in college -department of chest/ OPD drug store ) for easy
access & coordination between departments (OPD/IPD)
• STS of respective & TBHV posted in medical college to support NTEP activities in IPDs/OPDs.
Usually, Presumptive TB
patients are referred
NTEP Treatment
center
( NTEP + college staff )
• Counselling of Patient/family members, facilitating a test for HIV /diabetes, etc if missed
• Refer a patient for treatment to nearby PHI/TU/district /outside the district or state with a referral form with transit
medicine
• Entre information in the TB notification register and feedback provided to MO /faculty who diagnosed the TB patient
• Real-time Ni-kshay entry ( transfer in/out mechanism )
Central Lab
Microscopy/
NAAT Site
Radiology
Other test
• Core Committee to identify a Coordinator from the department who coordinates the NTEP activities along with the NTEP staff

13. Functions of Core Committee (3): Improve case notification
(2) Patient Flow-indoor patients
• Presumptive TB patient ( ALL) – identified, subjected to necessary investigations by ALL departments
• Screen All indoor patients for TB
• To track, the referral register to be kept in each dept- this will help to see the department-
wise referral.
• Further, this will be enrolled in Lab/NAAT register. Use NTEP formats (annex 15 A)
• Establish Linkages to TB diagnostic Centre -NAAT with a mechanism to send the samples to
or refer presumptive TB patient
• Patient diagnosed as TB in all departments (IPD)
• Initiate treatment with prescription/DISCHARGE CARD – DSTB
• PTE additional investigations for DRTB–refer patients to DRTB center (nodal/Dist level)
• ALL patients to be referred to NTEP Treatment center placed in medical college.
• TBHV posted in medical college support NTEP activities through IPDs/OPDs and STS to supervise the
treatment activities
Usually, patients
Samples sent
Central Lab
Microscopy/
NAAT Site
Radiology
Other test
NTEP Treatment
center
( NTEP + college staff )
• Core Committee to identify a Coordinator from the department who coordinates the NTEP activities along with the NTEP staff
• Counselling of Patient/family members, facilitating a test for HIV /diabetes, etc if missed
• Refer a patient for treatment to nearby PHI/TU/district /outside the district or state with a referral form with transit
medicine
• Entre information in the TB notification register and feedback provided to MO /faculty who diagnosed the TB patient
• Real-time Ni-kshay entry ( transfer in/out mechanism )

14. Functions of Core Committee (MCCC) (4)- data analysis
21.0
24.0
18.1
21.5
19.8
2.2 3.3 2.2 2.6 2.7
10%
14%
12% 12%
14%
0%
2%
4%
6%
8%
10%
12%
14%
16%
0.0
5.0
10.0
15.0
20.0
25.0
30.0
2018 2019 2020 2021 2022
Total Notification (lakhs) Notifciation from medical College (lakhs)
% Contribution
Total
Notification
(lakhs)
Notification from
medical college
(lakhs)
%
Contribution
2018 21.0 2.2 10%
2019 24.0 3.3 14%
2020 18.1 2.2 12%
2021 21.5 2.6 12%
2022
(Jan-Oct 22)
19.8 2.7 14%
Contribution of Medical Colleges to TB notification
(Jan-Oct 22)

15. 163808
109538 116841 122553
166446
111296
142153 147648
49.6% 49.6%
45.1%
45.4%
42.0%
43.0%
44.0%
45.0%
46.0%
47.0%
48.0%
49.0%
50.0%
0
20000
40000
60000
80000
100000
120000
140000
160000
180000
2019 2020 2021 2022
Microbilogical confimed TB (Medical college) Clinical diagnosed TB (Medical college)
% Microbilogical confimed TB (Medical college)
Functions of Core Committee (MCCC) (5)- data analysis
Contribution of Medical Colleges: Microbiologically Confirm TB
(Jan-Oct 22)

16. 123994
86099
104322
104524
10658 8731 9049 9289
8.6%
10.1%
8.7%
8.9%
5.0%
6.0%
7.0%
8.0%
9.0%
10.0%
11.0%
0
20000
40000
60000
80000
100000
120000
140000
2019 2020 2021 2022
Total EP TB Notified (Medical College)
Microbiologically confirm amongst EP TB (Medical College)
% Microbiological confirm EP TB (Medical College)
Functions of Core Committee (MCCC) (6)- data analysis
Contribution of Medical Colleges: EPTB
(Jan-Oct 22)
21.5%
23.5% 23.8% 23.5%
37.5%
39.0% 40.3%
38.7%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
45.0%
2019 2020 2021 2022 (Jan-
Oct)
Proportion of EP TB Cases ( India)
Proportion of EP TB Cases ( Medical College)

17. Functions of Core Committee (MCCC) (7)- data analysis
Contribution of Medical Colleges: Paediatric TB
22865
15863
18232
19447
5147
4033 4132 4401
22.5%
25.4%
22.7% 22.6%
15.0%
17.0%
19.0%
21.0%
23.0%
25.0%
27.0%
0
5000
10000
15000
20000
25000
2019 2020 2021 2022
Total Paediatric TB Cases notified
Microbiological confirm amongst total pediatric TB Cases notified
% Microbilogical confirm TB amongst all Paediatric TB notified
330254
220834
258994 270201
22865 15863 18232 19447
6.92%
7.18%
7.04%
7.20%
4.75%
5.25%
5.75%
6.25%
6.75%
7.25%
7.75%
0
50000
100000
150000
200000
250000
300000
350000
2019 2020 2021 2022
Total TB patienst notified by medical college
Total Paediatric TB Cases notified
% of Paediatrc TB patients notified
(Jan-Oct 22)
(Jan-Oct 22)

18. Functions of Core Committee (MCCC) (7)- data analysis
Contribution of Medical Colleges: Infrastructure
TB Diagnostic and
Treatment centre
579**/645*
NAAT
(CBNAAT, Truenat)
370/579
DR-TB Centres
293 /579
( Nodal-117, DDR-TBC-176)
C & DST Labs 36/90 ( India)
* List of medical colleges as per the NMC * * Involved in NTEP

19. Records and report
• NTEP Request Form for examination of
biological specimen for TB
• Lab register
• NTEP Laboratory Register for CBNAAT &
CDST
• DS TB Treatment card
• TB ID card
• Referral for Treatment form
• TB Notification Register
• NTEP PMDT Treatment Book
• Medical College Quarterly reporting format
( Excel )

20. Way Forword
• Coordination between departments (health & medical education) for
effective collaboration
• Medical Colleges /District TB Centers
• STF / State TB office
• Revision of core committee at each college referring to revised SOP (SOP
will be released soon)
• Conduct meetings regularly- CC /STF /state OR committee
• Greater focus on teaching TB & NTEP to medical students (UGs/PGS)
• so that all graduates are able to diagnose and treat TB patients as per NTEP
• Wider sensitization of medical college faculty /PGs/Interns/UG in the
NTEP

21. Template for Core Committee
Template for CC meeting

22. Thank you