STLS: Programme Implementation Plan in NHM

The State Programme Implementation Plan (PIPs) for health and family welfare services under National Health Mission (NHM) funding spell out the strategies to be deployed, budgetary requirements and aimed health outcomes.

PIPs are the most crucial documents in NHM through which the states/ Union Territories (UTs), identify and quantify the targets required for programme implementation for the proposed year.

PIPs are prepared by states annually as a document which is then finalised in the National Programme Coordination Committee (NPCC) meeting for administrative approval.

On finalisation of the budget in the NPCC meeting, it becomes an official document available in the Ministry's site for general viewing.

Importance of PIP

• Its a plan according to which the different activities are carried out and performance of each activity can be monitored against it.
• Approval of PIP implies that states/districts can carry out the activities mentioned in the plan.
• It is the indicator of the total budget requirement of the state for carrying out the programme activities

PIP Preparation Process under NHM

A bottom-up approach is followed for preparing the State PIP wherein the inputs are taken from blocks, cities, Community Health Centre (CHC)/ Peripheral Health Centre (PHC), and village level to prepare a DHAP. These DHAPs are then consolidated to prepare a State PIP.

Budget Heads

A total of 18 different budget heads comprises the PIP. These include:

Each budget annexure is linked to the budget summary sheet and the corresponding budget abstracts.

National Tuberculosis Elimination Programme (NTEP) is one of the many National Health Programmes that have come under the umbrella of the NHM. NTEP is now a flagship component of NHM and provides technical and managerial leadership to anti-tuberculosis activities in the country. NHM, in turn, is responsible for making funds available to carry NTEP related activities. The budget heads of NTEP may differ from other programmes. Hence, after the activities to achieve TB-elimination based on the Detect-Treat-Prevent Build strategies under National Strategic Plan (NSP) for TB Elimination 2017-2025 are planned, they have been aligned with the Financial Management Report (FMR) codes of NHM. This facilitates district, state, and central NHM to consolidate the individual PIPs for necessary approvals.

Resources

• E-Training Module on Budget/ PIP Preparation. National Health Mission. Ministry of Health and Family Welfare, Government of India.
• PIP Guidance Note 2018-19. National Health Mission, Ministry of Health and Family Welfare, Government of India.
• Training Modules (5-9) for Programme managers & medical officers, Central TB Division, Ministry of Health and Family Welfare, Government of India.

Assessment

The different meetings conducted at the Tuberculosis Units (TU) are:

1) Patient-Provider Meetings: These meetings are organized by STS and conducted by the MO-TC for the patients.The purpose of these meetings are to counsel patients who are already on treatment or who are about to initiate treatment. This provides an opportunity for interaction between provider and patient. During these meetings patients are provided basic information about tuberculosis, cough hygiene, importance of completing treatment, possible adverse drug reactions and how to manage them, importance of follow up sputum examination and TB preventive treatment.

2) Community-level Meetings: These meetings are organized by the STS and conducted by the MO-TC for the patients, general public, community leaders/ people’s representative including Self-help Groups (SHGs), Non-Governmental Organisations (NGOs),  community volunteers, traditional healers, people practising other systems of medicine.These meetings are mainly conducted with the aim to increase the awareness levels in the population about TB, enhance referrals, improve adherence to TB treatment as well as to address the stigma , discrimination associated with the TB.

3) Sensitisation Meetings for Panchayati Raj Institutions (PRIs), NGOs, Private Providers (PPs): These meetings are organized by the District Public Private Mix (PPM) coordinator/ STS for elected representatives under the 3-tier Panchayati Raj System, State Government Health Systems (SGHS), NGOs, community leaders and community volunteers. The purpose of these meetings are to create awareness about the need for public action on TB and generate specific commitment from target audience on how they would support TB elimination efforts.

4) School-based meetings: These meetings are conducted by the STS at the schools and colleges for the teachers and students. The purpose of these meetings are to generate awareness amongst students and teachers of schools and colleges regarding tuberculosis and improving referrals for TB testing.

Resources

• Training Modules (5-9) for Programme Managers & Medical Officers, CTD, MoHFW, India, 2020.
• National Strategic Plan for Tuberculosis Elimination 2017–2025, MoHFW, India, 2017.

Assessment

Review meetings are conducted at each Tuberculosis Units (TU) on a monthly basis in order to review the activities and address if any issues. The MO-TC is responsible for conducting these meetings 

The other participants are: Senior Treatment Supervisors (STS),  TB Health Visitor (TBHV), Senior TB laboratory Supervisor (STLS), General Health system staff and Treatment supporters.

Activities reviewed at TU level

The various activities reviewed during the TU review meetings are Case finding, Sputum smear examinations conducted at all the Designated Microscopy Centres(DMCs) of the sub-district,, Supervisory visits conducted by STS and STLS, Categorization of diagnosed patients based on the treatment regime, Treatment outcomes of cohort-wise patients who were expected to complete the treatment during the period, Information, Education, Communication (IEC) activities conducted, Status of the Ni-kshay patient registrations, Direct Beneficiary Transfer (DBT) linkages and Ni-kshay Aushadhi Updation, Drug supply and other logistics to all peripheral health institutions (PHIs), Returned drug stocks if any and all other Programmatic performance indicators.

Role of STS and STLS in supporting MO-TC to review the performance of the TU

The STLS must:

• Ensure all notified TB patients in the block are tested and results have been obtained.

• Maintain a list of all follow up smear positive patients separately and submit to the  MOTC before the review.

• Complete Sputum collection for all presumptive DR TB patient identified.

• Visit all DMCs during the month to identify if any concerns and bring them to the notice of the MOTC.

• Update all reports related to diagnosis and follow up examinations on Ni-kshay.

The STS must: 

• Update the list of new and old patients on treatment for the reviewing month.

• Correctly classify patients as per their TB treatment regimen and record all related events in Ni-kshay. 

• Maintain an up-to-date list of all treatment interrupters and lost to follow up patients, with the duration of interruption and reasons that lead to the same.

• Prepare a report of the patient-wise visits conducted during the period.

• Prepare a report on performance of the treatment supporters.

• Prepare a list of all pending DBT linkages and report the reasons for backlogs.

• Supervise and report all the community engagement activities conducted during the reviewing month and update on planned activities.

• Prepare report on all drug issue and returns during the month.

• Report on involvement in private sector engagement activities conduced (if any) during the period.

With support from the STS and STLS the MOTC can review the performance and shall further conduct home visits for the patients in order to address the issues.

Resource

• TRAINING MODULES (5-9) FOR PROGRAMME MANAGERS & MEDICAL OFFICERS, CTD, MoHFW, India,2020.
• NATIONAL STRATEGIC PLAN FOR TUBERCULOSIS ELIMINATION 2017–2025, MoHFW, India, 2017

Assessment

Role of STLS in District Review meetings

Role of STLS in District Review meetings

Senior Tuberculosis Laboratory supervisor (STLS) is responsible for ensuring quality assured TB diagnostics in the district and hence, plays an important role in the district review meetings. 

• STLS compiles and presents the data on:

•      Presumptive TB case examination and notification rate against the target estimated.
•      Universal Drug Susceptibility Testing (UDST) status of the notified TB patients.
•      Number of diagnosed TB patients whose samples were sent to the Intermediate Reference Laboratory (IRL) or Culture and DST (CDST) laboratory for First line-Line Probe Assay (FL-LPA), Second line-Line Probe Assay (SL-LPA), and Drug Susceptibility Testing (DST).
•       Number of Notified cases put on treatment.
•      Treatment outcome details
•       Tuberculosis Infection (TBI) screening among the household contacts of the notified TB patients.

•    STLS during the review meetings presents the findings of the On-Site Evaluation (OSE) visits conducted and gives suggestion regarding further improvement of the diagnostic services in the district.

•     SLTS during the review meetings provides feedback on the training status and competency level of the Laboratory technicians (LTs) based upon the findings of Blinded and Non-Blinded Rechecking of the Acid Fact Bacilli (AFB) smears. 

•      STLS also provides the Status of Laboratory consumables, Staining reagents, CBNAAT Cartridges and Truenat Chips in the district. 

•    STLS also presents the findings of Active Case Finding (ACF) Campaign during the review meeting and provides feedback on the problems encountered and ways to overcome these problems in future campaigns. 
  

Resources

• Training Modules (5-9) for Programme Managers & Medical Officers.  National TB Elimination Programme Central TB Division Ministry of Health & Family Welfare, Government of India, New Delhi. 

Assessment