First Day As Principal, Medical College, Calicut

Article for the Souvenir of State Task Force of RNTCP-Kerala State

What RNTCP gave me?

Today in India RNTCP is a lifestyle. At least for the thousands of health workers involved in this programme, it indeed is a life style. We fought hard for one and a half decades to cover the whole country, to save millions of life, to reduce poverty and to alleviate sufferings.

I was attracted to RNTCP in the year 2000 when I was working in Alappuzha. I had the opportunity to be associated with the RNTCP unit of Alappuzha Medical College. Next year I was invited for the launching of RNTCP in Calicut district. When I was posted back to Calicut in 2002 I took over as core committee convener of Calicut Medical College. The staff of RNTCP unit was an enigma to me at that time. With negligible help from most of the departments the few workers of RNTCP showed immense potential and an untiring resolve which really was a motivating factor for me. The extraordinary commitment and dedication shown by the programme’s large contingent of NGO workers, who work with the patients to make DOTS services available and accessible even in the most remote corners of India is an extraordinary feat.

I thought that the doctors were a little hesitant to accept DOTS. There were many doubts, most of them irrelevant and baseless. Private practitioners were more suspect. At this point I have worked out my plan. I have decided to take up the mission of propagating the scientific basis of DOTs. I was immensely helped by few of my friends especially my colleagues and the WHO consultants etc.

The task was cut out. My job was to tell others to believe the facts. Any criticism is acceptable within the framework. I felt that those who are criticizing DOTS are those who are not practicing it. It is very simple, involve in the programme, start practising and then try to find out the defects. Programme is flexible and any genuine doubts can be addressed. For that all of us especially doctors should believe that DOTS strategy is cost-effective and is today the international standard for TB control programmes. To date, more than 180 countries are implementing the DOTS strategy. RNTCP has consistently achieved treatment success rate of more than 85%, and case detection close to the global target.

In 2007 I was appointed as State task force chairman. I just made a decision to manage by participation. Every body should be given some role in RNTCP programme. The STF meetings were planned frequently and it was decentralized. Every three months we will meet in one of the low target colleges. Their strength, weakness and opportunities were exposed to them and naturally their attitude towards the programme changed immediately. Our aim was to start RNTCP core committees in all the 18 medical colleges. I am sure that almost all the colleges were brought in to the mainstream. All of them were motivated to start DOTS centre and Microscopy centre. Man power was provided where ever necessary.

Another area where we could contribute during my tenure was operational research. It later was mentioned in one of the subsequent NTF meetings as ‘Kerala Model”. We could motivate the faculty to submit about 11 OR proposals, out of which 7 were approved by ZTF. We could get fund approval for many PG theses during that period.

What RNTCP gave me? I always felt that RNTCP is a model programme of health intervention, a unique one for the whole world. Being an active worker, eventhough for a brief period, I enjoyed my job. I got due respect and immense help from all around me. It was really a capacity building exercise for me. In other words it was a job enrichment period for me. For my masters in Business management I took up one aspect of RNTCP to prepare my thesis. The study on human resource management in RNTCP was a challenge to me and an eye opener too.

There is a rapidly growing realization that human resources for health are crucial to the delivery of the services focused on the human development goals and the reforms in service needed to achieve them. Clearly reforms in services depend upon having the right people in the right place at the right time to deliver accessible, effective and affordable services. The performance of health care systems depends ultimately on the knowledge, skills and motivation of the people responsible for delivering the services. It is essential to have adequate staff with right skills, knowledge and attitude to successfully implement and sustain RNTCP. More over there should be regular efforts for capacity building such as training, retraining, reviews and appraisals. RNTCP is one programme where all these are properly taken care of. It is our duty to see that the work force is able to deliver the services at the highest level. There are minor problems leading on to stress at work But during the core committee meetings, state task force meetings and subsequent training sessions problems are discussed and solutions are suggested.

It is important that to maintain the success there should be committed workers. Job satisfaction and job stress are two important parameters which decide the motivational level of these workers. I have tried my level best to focus on these parameters during my tenure. Each stratum of workers needs different scale to assess their motivational level and different strategy to improve that. When I look back I feel that I had fairly an easy journey and I particularly remember my colleagues who earnestly put in their effort to make my life easier.

Dr C Ravindran MD,DTCD,MBA

Professor of Pulmonary Medicine & Dean

Medical College, Calicut

Former Chairman, STF-Kerala

Member, Governing council, TB association of Kerala

ravindranc@calicutmedicalcollege.ac.in