India - Tuberculosis Control Project

Report No. PIC729 Project Name India-Tuberculosis Control Project (@) Region South Asia Sector Health Project ID INPA10473 Borrower India, acting by its President Implementing Agency Government of India, State Governments and Municipal Corporations Ministry of Health Room #345 A-Wing, Gate #5 Nirman Bhawan New Delhi 110001 Appraisal Date January 1996 Board Date March 14, 1997 Date PID Prepared August 18, 1997 1. Project Objectives. The objectives of the project will be to reduce mortality, morbidity and disability due to TB by curing TB cases, thereby reducing the incidence of infectious TB, the annual risk of infection and the development of drug resistance. Specifically, the project will: (a) diagnose and treat a minimum of 1.9 million TB cases including more than 800,000 smear-positive and severe TB cases; and (b) achieve cure rates of at least 859 of newly-diagnosed smear-positive cases in the RNTP districts, the rates achieved in the pilot sites; c) provide treatment with daily short-course chemotherapy to 850,000 smear positive patients in the SCC districts and prepare those districts to adopt the revised strategy; (d) treat about 230,000 smear-positive patients with conventional drugs in non-SCC districts; (e) improve diagnosis to reach at least 50t smear-positive cases as a percentage of total diagnosed cases in RNTP and SCC districts; and (f) improve the system of patient registration and follow-up to allow monitoring of treatment completion and cure in the SCC districts. 2. Project Description. The project will finance activities and inputs under three main components: (i) improving the quality, access and outcomes of TB treatment; (ii) developing institutional and operational research capacity and enhancing technical, managerial and interpersonal skills; and (iii) developing information, communication and outreach activities and promoting community involvement. Overall, the project will initiate a shift in the epidemiological profile of tuberculosis in India by focusing on the cure of infectious patients. 3. Project Scope. The Project will constitute a time-slice financing of the national TB Control Program over five years with the purpose of setting up the institutional and managerial infrastructure to establish the Revised Strategy for Tuberculosis Control (RNTP) in a larger scale, and to facilitate its gradual  expansion to the entire country within an 8-12 year time frame. 3.1 The project will strengthen the National TB Program for the entire country through the following interventions:(a) full implementation of the Revised Strategy for TB control (RNTP) in 102 districts; (b) strengthening of the National TB Program (NTP) in 203 districts now nominally under short-course chemotherapy (SCC), in preparation for initiating RNTP activities in the future; and (c) strengthening provision of services under conventional TB treatment in 154 non-SCC districts. This will involve modification of Program policies and procedures through new operational and technical guidelines, strengthening of the National and State Tuberculosis Demonstration Centers, strengthening of the central, state and district TB units, establishment of the required management systems for implementation of the RNTP, improved and expanded selection, training and retraining of staff, improved drug procurement, planning, storage and distribution, rigorous monitoring and supervision, and effective communication and information systems. 4. Project Implementation. The project will be implemented in a decentralized fashion through the structure of the National Tuberculosis Control program, the existing health system at the state level and below, and NGOs experienced with community participation and health sector activities. 5. Project Cost and Financing. The project will be centrally sponsored. The total cost of the project is estimated at RS 7,492.8 million or US$176.4 million equivalent including taxes and duties estimated at US$88.1 million. The IDA portion of the financing arrangements amounts to about 86.1 percent of the total project costs net of taxes. The Government of India will finance the remaining costs of US$22.9 million plus all taxes and duties (US$11.1 million). 6. Environmental and Social Aspects. The project will not present any major environmental concerns. It will make adequate provision for disposal of hospital waste where relevant. Concerning the social aspects, one of the project's special emphases is in providing services to the most disadvantaged populations, in particular, urban slum and tribal areas. Two social assessments of tuberculosis in India were commissioned by the Government of India and demonstrated that a major barrier in TB control is the financial constraints of the poor to pay for the medicines, transportation or doctor's fees and that the poor were the larger users of government facilities. The project design will reduce these barriers and increase the credibility of the Government's TB health care system. Contact Point: Public Information Center The World Bank 1818 H Street N.W. Washington, D.C. 20433 - 2 -  Telephone No.: (202) 458-5454 Fax No.: (202) 522-1500 Note: This is information on an evolving project. Certain components may not necessarily be included in the final project. Processed by the Public Information Center week ending August 22, 1997. - 3 -