Patient Records : Unlocking the Value

The Navi Mumbai Municipal Corporation (NMMC) was set up in 1995. Within two years it had established urban health posts (UHPs) and MCH centres.In 1989, recognising the woeful lack of municipal health services in Navi Mumbai, the organisation decided to extend the scope of its work to that area and to include TB patients. Dr Nagarajan, supervisor at the NMMC’s First Referral Unit (FRU) in Vashi says the corporation had noted Alert’s work with leprosy, conducted out of municipal dispensaries. Why not rope in Alert India to run the TB programme as well? The NMMC approached Alert India in 1998.

Under Alert, treatment was provided to all registered TB patients at the NMMC. Since the organisation maintained patient records, it now became possible to determine the effectiveness of the programme and follow up on people who didn’t come in to pick up their fortnight’s drugs from the central depot.

The NMMC appointed chest physicians, dispensers and laboratory technicians who worked alongside Alert staff. It also provided space for the TB unit at the First Referral Unit. All suspected TB cases in Navi Mumbai were sent to the FRU for tests, registration and follow-up. Drugs provided by the NMMC were dispensed at the FRU.

However, while availability of drugs was not a problem, distances were — patients outside the township of Vashi, where the FRU is situated, had to travel between five and 15 km to pick up their medication. Gita Balasubramanian, project coordinator of Alert’s TB programme in the area says: At times we paid them the money ourselves to make sure they came.

This first collaboration ended on December 31, 2000, after which Alert India’s responsibility was to continue providing treatment to all patients remaining on the rolls, till the last one was cured.

Between November 1998 and 2000, the NMMC/Alert non-Directly Observable Treatment TB programme had 2,622 registered patients. The last patient completed treatment/defaulted/died/ or was transferred in October 2001. According to a report on the programme, overall, 64% of patients completed treatment and were cured. A little less than 50% of sputum-positive patients (572 out of 1,028) became sputum-negative and were declared cured.

Of the 1,069 patients who did not complete treatment, 704 (27%) defaulted, stopping before the end of treatment. Treatment failed for 36 patients, 99 died and 107 were transferred to other areas.

“A 64% cure rate was a good success rate in those circumstances,” says Joy Mancheril, assistant director of the project. “It must be considered better than the earlier programme, which didn?t have any idea how many were cured.”

In November 2000, the NMMC qualified for the Directly Observable Treatment (DOTS) — Short Course and took over the TB programme from Alert India.

However, when the NMMC reviewed its first quarter in April 2001, it decided to re-involve Alert India. From May 2001, Alert worked with the NMMC to follow up on all DOTS patients in five urban health posts in two zones: Turbhe Sanpada and Airoli-Dighe.

Alert’s current caseload represents about 50% of diagnosed TB patients in the NMMC. A total of 1,219 patients were registered under DOTS in Navi Mumbai between January 1 and December 31, 2001. Since DOTS evaluation is completed five quarters down, the NMMC is yet to finalise its report.

Dr Dayanand Katke, medical officer in charge of the NMMC?s DOTS programme claims that they have an 85% success rate. A preliminary report by Alert indicates that of the 736 patients on their register cumulatively, 324 are off their registers; of these, 66 have defaulted — a defaulter rate of 18%.