CDMO Review Meeting

21.01.10

RNTCP – Goal and Objectives• Goal

– The goal of TB control Programme is to decrease mortality and morbidity due to TB and cut transmission of infection until TB ceases to be a major public health problem in India.

• Objectives as per the millennium development goals – To achieve and maintain a cure rate of at least 85% of new sputum

positive TB patients – To achieve and maintain a case detection of at least 70% of new

sputum positive TB patients

• The current focus is on achieving universal access to free quality assured TB services for all

the patients in the community

New Smear Positive Case Detection Rate, 2009

National Level- 72%

< 60% (5 states)60-69% (7 states)

> 70% (8 states)

Where we stand

2006 2007 2008 2009 (1-2 qtr)

ANSP-CDR

(%)

TSR-NSP (%)

ANSP-CDR (%)

TSR-NSP (%)

ANSP-CDR (%)

TSR-NSP (%)

ANSP-CDR (%)

TSR-NSP (%)

Sikkim 116% 88% 112% 86% 108% 85% 122% 86%

Delhi 90% 87% 87% 86% 86% 87% 94% 87%

Himachal Pradesh 81% 89% 81% 89% 82% 89% 90% 89%

Andhra Pradesh 74% 87% 81% 87% 81% 88% 82% 89%

Rajasthan 80% 88% 81% 89% 81% 89% 82% 89%

Gujarat 77% 87% 78% 87% 78% 87% 78% 87%

West Bengal 78% 87% 77% 87% 76% 86% 77% 85%

Tamil Nadu 68% 84% 68% 83% 67% 85% 66% 86%

Orissa 59% 85% 65% 86% 66% 87% 70% 86%

Uttar Pradesh 52% 87% 56% 86% 66% 87% 71% 88%

Kerala 43% 84% 64% 83% 65% 83% 68% 83%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

110%

120%Q

tr1

-99

Qtr

2-9

9Q

tr3

-99

Qtr

4-9

9Q

tr1

-00

Qtr

2-0

0Q

tr3

-00

Qtr

4-0

0Q

tr1

-01

Qtr

2-0

1Q

tr3

-01

Qtr

4-0

1Q

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-02

Qtr

2-0

2Q

tr3

-02

Qtr

4-0

2Q

tr1

-03

Qtr

2-0

3Q

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-03

Qtr

4-0

3Q

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-04

Qtr

2-0

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4Q

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-05

Qtr

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5Q

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-05

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5Q

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Qtr

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6Q

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6Q

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-07

Qtr

2-0

7Q

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-07

Qtr

4-0

7Q

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-08

Qtr

2-0

8Q

tr3

-08

Qtr

4-0

8Q

tr1

-09

Qtr

2-0

9Q

tr3

-09

Annualised New S+ve CDR Success rate

•Population projected from 2001 census•Estimated no. of NSP cases - 85/100,000 population per year (based on recent ARTI report)

Annualized New Smear-Positive Case Detection Rate and Treatment Success Rate in DOTS Areas, Orissa, 1999-2009 3Q*

Target Zone - NSP CDR (%) vs Success Rate - 3Q09

Orissa State

SUNDARGARH

SONAPUR

SAMBALPUR

RAYAGADA

PURI

NUAPADA

NABARANGAPUR

Mayurbhanj

MALKANGIRI

KORAPUT

KHORDHA

KENDUJHAR

Kendrapara

KANDHAMALKALAHANDI

JHARSUGUDA

JAJAPUR

JAGATSINGHAPUR

GANJAM

GAJAPATI

DHENKANAL

DEBAGARH

CUTTACK

BHUBANESHWAR

BHADRAK

BAUDH

Bargarh

BALESHWAR

BALANGIR

ANUGUL

75%

80%

85%

90%

95%

100%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% 110% 120% 130% 140% 150% 160%

NAYAGARH - CDR (57%) and Success (59%)

High CDR and Low SuccessLow CDR and Low Success

High CDR and High SuccessLow CDR and High Success

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

Jagatsinghapur

NSP CDR RATE 3Q09

50%

50-70%

>70%

NSP CDR (%) - 3Q09

26%

32%

32%

38%

40%

41%

48%

48%

49%

49%

51%

52%

53%

55%

57%

57%

60%

62%

67%

20% 30% 40% 50% 60% 70%

JAGATSINGHAPUR

CUTTACK

BHADRAK

PURI

Kendrapara

KHORDHA

JAJAPUR

DEBAGARH

BHUBANESHWAR

BALESHWAR

SONAPUR

NABARANGAPUR

ANUGUL

Bargarh

NAYAGARH

BAUDH

SAMBALPUR

BALANGIR

Orissa State

TB Suspects examined per 100,000 population*, 2000-2009

* During RNTCP expansion phase, data for districts implementing partial quarters has been excluded

0

20

40

60

80

100

120

140

160

180

Qtr

1-0

0

Qtr

3-0

0

Qtr

1-0

1

Qtr

3-0

1

Qtr

1-0

2

Qtr

3-0

2

Qtr

1-0

3

Qtr

3-0

3

Qtr

1-0

4

Qtr

3-0

4

Qtr

1-0

5

Qtr

3-0

5

Qtr

1-0

6

Qtr

3-0

6

Qtr

1-0

7

Qtr

3-0

7

Qtr

1-0

8

Qtr

3-0

8

Qtr

1-0

9

Qtr

3-0

9TB S

uspe

cts

exam

ined

per

100

,000

pop

ulat

ion

Quarters

158

INDIA

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

Jagatsinghapur

SUSPECT EXAMINED / LAKH / QTR-

3Q09

<100

100-150

>150

Suspect Examination Rate - Per Lakh Per Quarter - 3Q09

74

79

82

85

90

95

97

98

98

109

110

111

119

122

130

137

60 70 80 90 100 110 120 130 140 150

KHORDHA

BAUDH

JAJAPUR

NABARANGAPUR

BHADRAK

JAGATSINGHAPUR

CUTTACK

Kendrapara

SONAPUR

DEBAGARH

BALESHWAR

PURI

Bargarh

BALANGIR

KALAHANDI

Orissa State

Districts below the State Average

% of PHIs referring >2% of New Adult OPD cases for Sputum Examination

0%

1%

1%

4%

4%

5%

6%

8%

10%

11%

11%

14%

14%

16%

16%

22%

24%

25%

0% 5% 10% 15% 20% 25% 30%

BALESHWAR

CUTTACK

JAJAPUR

BHADRAK

BHUBANESHWAR

JAGATSINGHAPUR

NAYAGARH

SONAPUR

Bargarh

SAMBALPUR

Kendrapara

DEBAGARH

NABARANGAPUR

KHORDHA

PURI

KALAHANDI

RAYAGADA

Orissa State

All PHI are expected to refer more than 2% of their new adult OPD for sputum examination

% of PHIs referring more Chest Symptomatics than the State average

25%

26%

28%

29%

31%

39%

41%

45%

57%

62%

66%

79%

91%

100%

0% 20% 40% 60% 80% 100% 120%

Orissa State

KENDUJHAR

KANDHAMAL

GANJAM

BALANGIR

SUNDARGARH

GAJAPATI

DHENKANAL

Mayurbhanj

JHARSUGUDA

KORAPUT

NUAPADA

MALKANGIRI

BAUDH

Initial Defaulter % - 3Q09

6.9%

7.3%

8.0%

8.3%

8.3%

8.4%

8.6%

9.4%

9.6%

10.6%

11.1%

11.8%

15.7%

16.0%

16.5%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Orissa State

Anugul

MALKANGIRI

Mayurbhanj

DEBAGARH

KENDUJHAR

KORAPUT

GAJAPATI

KALAHANDI

NABARANGAPUR

CUTTACK

BAUDH

SAMBALPUR

NAYAGARH

KANDHAMAL

Annualized Total Case Detection Rate - 3Q09

54

62

71

72

87

88

91

93

94

94

101

105

105

113

114

115

119

131

40 50 60 70 80 90 100 110 120 130 140

JAGATSINGHAPUR

Kendrapara

BHADRAK

CUTTACK

NABARANGAPUR

JAJAPUR

PURI

DEBAGARH

BALESHWAR

KHORDHA

BHUBANESHWAR

SONAPUR

ANUGUL

DHENKANAL

KORAPUT

Bargarh

BAUDH

Orissa State

< 80% (0 states)

80-84% (3 states)

> 85% (17 states)

New Smear Positive Treatment success rate- 2008

National Level- 87%

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

Jagatsinghapur

NSP Success RATE 3Q09

<80%

80-84%

>85%

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

Jagatsinghapur

NSP CURE RATE 3Q09

<75%

75-85%

>85%

NGO Involvement

• Sputum Collection: Nayagarh – 2• Sputum Transport: Nayagarh – 2,

Kendrapada – 9• DMC Scheme: One each in Puri, jajpur,

Kalahandi and Jharsuguda• LT Scheme: Jharsuguda 1• TU Scheme: 1 in Malkangiri• Nil in: Adherence Scheme, Slum Scheme

and TB HIV scheme

PP Involvement

• Only 2 Private Organizations involved under DMC scheme: one each in Sambalpur and Ganjam.

Poor ACSM

a) In spite of intervention by other partner agency like Lepra and The Union (apart from State Govt. initiative) TB awareness has not penetrated into the rural pockets.

b) Slum dwellers constitute a large percentage of urban population and the prevalence of TB is high amongst them. Awareness is still low in the slum population.

DOTS Plus

Progress of DOTS-Plus ProgrammeProgress of DOTS-Plus Programme(as on 30(as on 30thth September 2009) September 2009)

• Intermediate Reference laboratory (IRL) at Anti TB Demonstration & Training Centre, Cuttack accredited on 10th Aug’ 09.

The Way Ahead….• Expansion of DOTS Plus activities to the rest of

the State in a phased manner – the next two DOTS Plus sites planned at MKCG and VSS Medical Colleges.

• DOTS Plus wards in these two medical colleges may be constructed through NRHM funds. Meeting conducted in VSS – they have agreed to give space for the ward. NRHM to take up.

• Preparatory activities to be initiated for installation of LPA and Liquid Culture systems in the IRL at Cuttack. Four rooms identified in the ground floor of existing IRL – these have to be vacated and necessary civil works initiated.

Launch of DOTS Plus

1. Four RNTCP districts of Cuttack, Ganjam, Khurda and Bhubaneswar taken up for DOTS-Plus activity in 2009-10 in 1st phase.

2. Three MDR-TB cases identified so far (two from Cuttack and one from Khurda).

3. CAT-IV treatment started for MDR-TB patients from 11th November 2009. Secretary Health inaugurated the event.

FINANCE

> 70%

50% - 69%

25-49%

Total ExpenditureApril’09 – Sept’09

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

<25%

SOE for Dec’09 not submitted

Civil WorksApril 2009 - Sept 2009

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

Balangir

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

Nuapada

> 70%

50% - 69%

25-49%

<25%

SOE for Dec’09 not submitted

Payment of honorarium to DPApril’09 – Sept’09

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapa

Dhenkanal

Jagatsingpurg

Kalahandi

Kandhamal

Koraput

Malkanagirii

Nowarangpur

Rayagada

> 70%

50% - 69%

25-49%

<25%

SOE for Dec’09 not submitted

IECApril’09 – Sept’09

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

> 70%

50% - 69%

25-49%

<25%

SOE for Dec’09 not submitted

TrainingApril 2009 - Sept 2009

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

> 70%

50% - 69%

25-49%

<25%

SOE for Dec’09 not submitted

NGO / PP SupportApril’08- Sept’08

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapad

a

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

> 70%

50% - 69%

No Budget

<25%

SOE for Dec’09 not submitted

Misc.April’09 – Sept’09

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Nabarangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

> 70%

50% - 69%

25-49%

<25%

SOE for Dec’09 not submitted

Contractual ServicesApril’09 – Sept’09

Baleshwar

Mayurbhanj

Bhadrak

Kendrapara

Kendujhar

Jajapur

Puri

Cuttack

Sundargarh

Anugul

DebagarhSambalpur

Jharsuguda

Bargarh

Khordha

Nayagarh

Ganjam

Gajapati

Baudh

Sonapur

BalangirNuapada

Kandhamal

Kalahandi

Rayagada

Na barangapur

Koraput

Malkangiri

Dhenkanal

JagatsinghapurBMC

> 70%

50% - 69%

25-49%

<25%

SOE for Dec’09 not submitted

Thank You

Low cure rate (82%)Cause Steps taken to improvePoor counseling to patients/DPs • Counseling made mandatory for MO,

DMC/LT at the time of card initiation.• leaflet / booklet on DOTS supplied to DPs

Improper address verification HW/ASHA/AWW/NGO/any other DP to verify the address before putting under treatment.

Last sputum not done (in sputum +ve cases)

Last sputum examination made mandatory & DP’s honorarium granted only after last sputum examination.

Lack of feedback on transfer out cases DTOs’ monitoring electronically/ telephonically each month. Inter district coordination meetings held quarterly

Improper DOTS DTO, MO-TU, MO-PHI, STS to ensure DOTS

High Default

Timely supervision

Timely card updation

Redressing ADR

NGO involvement

Matter of Concern…

• Death Rates in all districts are above the expected norm of <4% except:– Anugul, Baleswar, Dhenkanal, Jagatsinghpur,

Khurda and Puri

Death Rates - NSN Cases - 3Q08

4.6%

4.7%

4.8%

5.2%

5.5%

5.5%

5.5%

5.6%

6.7%

7.1%

7.5%

8.1%

8.3%

10.4%

10.5%

11.5%

13.6%

0% 2% 4% 6% 8% 10% 12% 14% 16%

Orissa State

SAMBALPUR

BALANGIR

Mayurbhanj

RAYAGADA

KALAHANDI

SUNDARGARH

ANUGUL

PURI

Bargarh

KANDHAMAL

JHARSUGUDA

BAUDH

KORAPUT

JAGATSINGHAPUR

MALKANGIRI

DEBAGARH

Why are so many new sputum negative cases dying?

Default Rates in NSN Cases - 3Q08

7.0%

7.7%

7.9%

8.0%

8.2%

8.7%

10.5%

11.2%

13.2%

13.3%

13.4%

13.6%

16.9%

17.4%

0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 20%

Orissa State

SUNDARGARH

KHORDHA

BALANGIR

JAJAPUR

BHADRAK

GANJAM

NAYAGARH

NABARANGAPUR

GAJAPATI

DHENKANAL

DEBAGARH

BALESHWAR

KALAHANDI

Why are so many new sputum negative cases defaulting treatment?

Prescription Audit of Anti TB Drugs

SECY. HEALTH HAS DIRECTED THE DC OF ODISHA TO SEE THAT NO ANTI TB DRUG BE SOLD WITH OUT PRESCRIPTION BY A REGISTERED MEDICAL PRACTIONER.

Vacancy status of key contractual postsVacancy status of key contractual posts(as per PM report of 3(as per PM report of 3rdrd and 2 and 2ndnd Qtr 09) Qtr 09)

To be appointed by the respective district:• Senior Treatment Supervisor- 2 (Mayurbhanj – 1, Kalahandi – 1)• Senior TB Laboratory Supervisor- 10 (One each in Sundergarh, Rayagada,

Khurda, Cuttack, Bargarh, Baleswar, Balangir and Angul and Two in Mayurbhanj)

To be appointed by NRHM at the State level:• Laboratory Technician (RNTCP)-29

– Total LT sanctioned (DMC)-546

NRHM moved on 02-06-08 to initiate process of recruitment of contractual Laboratory Technician (LT)

LT Sanctioned In position Vacancy

Govt 440* 419 21

Contractual 106 98 8

Vacancy status – State LevelVacancy status – State Level (to be appointed by NRHM at the State level)(to be appointed by NRHM at the State level)

• One Microbiologist for ATD&TC, Cuttack

• One Contractual MO – VSS Medical College, Burla

• Contractual MO – one each at DTC Koraput and Nuapada

• One Accountant Post at State TB Cell

• Communication facilitator: One each at Koraput and Baripada

Drug Management

1. DTOs to stick to the timetable for quarterly indent of Anti TB Drugs.

2. Return the short expiry drugs at least 6 months before the date of expiry.

3. Any surplus drug not likely to be utilized should be returned back to the SDMU.

4. The practice of sending drug boxes to the PHI through the STS in motorcycle should be stopped.

5. Necessary steps to be taken to ensure that the MO-TCs send the drug boxes to the concerned PHI as per schedule.

6. The person handling the TB drugs at the District level should be well versed with Pro-MIS. All receipts and expenditure should be made online through Pro-MIS.

Trends of Cure Rates, Success rates and Conversion Rates

84

8283 83 83

86 8685

8687

8687

8687

89

8788

8786

89 89

8788

70

73 7374

77

79 7980

77

79 7980

8180

82 82 82

84

8283

82 82 82

78

82

84 8485 85

86 8685 85

86 86 8685

8786

87 8786

8786 86 86

65

70

75

80

85

90

95Q

10

4

Q2

04

Q3

04

Q4

04

Q1

05

Q2

05

Q3

05

Q4

05

Q1

06

Q2

06

Q3

06

Q4

06

Q1

07

Q2

07

Q3

07

Q4

07

Q1

08

Q2

08

Q3

08

Q4

08

Q1

09

Q2

09

Q3

09

Conv Cure Success

NSP CDR (%) - Districts That Have Deteriorated

146%150%

51% 52%

59%

52%

37%

74%

109%

69%

86%

79%

48% 49%

55%

48%

32%

68%

102%

60%

76%

68%

148%144%

0%

20%

40%

60%

80%

100%

120%

140%

160%

May

urbhan

j

MALKANG

IRI

DEBAGARH

BALESHWAR

Bargar

h

JAJA

PUR

CUTTACK

KANDHAMAL

KENDUJHAR

SAMBALPUR

KORAPUT

NUAPADA

NS

P C

DR

%

3Q08 3Q09

The Programme Indicators (1)

a) Suspects Examined / Lakh / QuarterNorm >150 State Achievement = 137

Major Causes of low suspects examination:1. Block wise referrals not monitored at CDMO review meetings2. Referrals from PHC (N) very low / not monitored3. Sub Center wise referrals not monitored at Block level4. Referrals from other Care providers / NGOs / PPs negligible

b) Annualized new sputum +ve case detection / lakh Norm:NSP Case Detection Rate > 60 / lakh / year NSP Case Detection Rate (%) >70% State Achievement – 57 / Lakh / year (67%)

The Programme Indicators (2)

c) Annualized total case detection rate Norm – 230 / Lakh / yearState Achievement – 131 / lakh Major Causes:1. Low detection of NSN and EP Cases

• Diagnostic algorithm not followed• Defective X Ray machines / shortage of X-Ray technicians• Suboptimal involvement of Medical Colleges / Private

Practitioners

2. Very Low Detection of Retreatment Cases• Improper history taking

The Programme Indicators (3)

Poor Access to Health Facility

1. Difficult demographic profile of the State.2. Lack of manpower (mostly LTs) to manage

microscopy centers as per need.

Initial Defaulters1. Defined as diagnosed as sputum positive TB in the

Lab but failed to get registered for treatment. 2. During last Quarter 482 diagnosed TB cases did

not turn up for treatment, which constitute 7% of the total cases detected.

3. Although some of these would have started treatment and will get registered in the subsequent quarter, there are many cases which are missed out completely after diagnosis.

4. Had these been initiated on treatment, the case detection in the State could have been substantially higher.

e) Cure rate Norm - >85%State Achievement – 82%

Major Causes:1. Mostly high Deaths and Default Rates in many districts2. DOT not being followed3. Inadequate counseling at all levels (especially by the

treating physician)4. Very low feedback of Transferred out cases

The Programme Indicators (5)

Cure Rate - NSP Registered in 3Q08

48%

73%

76%

76%

76%

78%

79%

79%

80%

80%

80%

80%

82%

82%

82%

0% 10% 20% 30% 40% 50% 60% 70% 80%

NAYAGARH

NABARANGAPUR

SONAPUR

KALAHANDI

GANJAM

DEBAGARH

KENDUJHAR

GAJAPATI

KORAPUT

BALESHWAR

KANDHAMAL

NUAPADA

BALANGIR

BHADRAK

Orissa State

Districts whose Cure Rates have gone down from the previous quarter

48%

79% 78%76%

73%

80%82%

88%

93%

80%82%

79%

85%

62%

87%86%

82%

79%

86% 85%

91%

96%

82%83%

80%

86%

40%

50%

60%

70%

80%

90%

100%

NAYAGARH

KENDUJHAR

DEBAGARH

SONAPUR

NABARANGAPUR

NUAPADA

PURI

JHARSUGUDA

Kendra

para

KORAPUT

BALANGIR

GAJA

PATI

May

urbhan

j

Cu

re R

ate

3Q08 2Q08

Districts whose Cure Rates have Improved / remained Constant from Previous Quarter

91%

84%

76%

92%

83%

87%

88%

76%

92%

80% 80%

86%

82%

85%84%

88%

86%

81%

85% 85%

74%

88%

76% 76%

80%

76%

78%77%

75%

86%

84%

82%

91%

82%

84%

76%

85%

91%

70%

75%

80%

85%

90%

95%

DHENKANAL

BAUDH

KALAHANDI

Bargar

h

Oris

sa S

tate

SUNDARGARH

ANUGUL

RAYAGADA

JAJA

PUR

KHORDHA

GANJAM

JAG

ATSING

HAPUR

BALESHWAR

KANDHAMAL

CUTTACK

BHADRAK

SAMBALPUR

MALKANG

IRI

BHUBANESHWAR

Cu

re R

ate

3Q08 2Q08

Contd…

• The IRL was formally inaugurated and dedicated to the people of Odisha on 11.08.2009 for diagnosis of MDR-TB cases.

Secretary Health Inaugurating the DOTS Plus Ward at SCB Medical College, Cuttack

Secretary Health giving the first dose of DOTS Plus medication to MDR TB patient (Y. Sita) in the DOTS Plus ward

Secretary Health giving the first dose of DOTS Plus medication to MDR TB patient in the DOTS Plus ward

Secretary Health giving the first dose of DOTS Plus medication to MDR TB patient in the DOTS Plus ward