Functions and Integrated Services of the DMC

The key level for the management of public health services is the district​ level. The District Tuberculosis Centre (DTC) is the nodal point for tuberculosis (TB) control activities in the district​.

Functions of the DTC

The primary role of the DTC is a managerial one. The DTC is the central program management unit of the district responsible for all activities related to National TB Elimination Programme (NTEP) implementation such as:

The Intermediate Reference Laboratories (IRLs) function as a culture and drug susceptibility testing (C&DST) facility for the state level.

In addition to performing CDST, IRL is also responsible for:

Those who are suspected of having TB disease are first screened for symptoms like cough and fever for more than 2 weeks, blood stained sputum and weight-loss. If found positive on screening, then TB patients are referred for testing to the nearest health facility. If diagnosed with TB, then they are subsequently initiated on treatment.

The State TB Cell or STC is the state-level implementing structure of the National TB Elimination Program (NTEP). It is the leading institution for management of NTEP activities at the state level. 

The STC is a State Government entity that acts as the bridge between the Central and State Governments for implementing the NTEP. It works under the guidance of the Central TB Division (CTD), and it oversees the program implementation at the districts.

• National Reference Laboratories (NRLs) conducts annual on-site evaluation/supervisory visits to laboratories for assessing the quality of microscopy, culture and drug susceptibility test (C&DST), and for improvement of the overall laboratory quality. 
• NRLs also assist Central TB Division (CTD), in developing laboratory guidelines, standard operating procedures (SOPs), and conduct training to state-level Intermediate reference laboratories (IRLs) and other technical issues.

There are 6 national institutes under the National Tuberculosis Elimination Programme (NTEP). These include:

1. National Institute of Research in Tuberculosis (NIRT), Chennai
2. National Tuberculosis Institute (NTI), Bengaluru
3. National Institute of TB & Respiratory Diseases (NITRD), New Delhi
4. Central JALMA Institute of Leprosy other Mycobacterial diseases (JALMA), Agra
5. Regional Medical Research Centre (RMRC), Bhubaneswar
6. Bhopal Memorial Hospital and Research Centre, (BMHRC) Bhopal

The Central TB Division (CTD) is the apex institution for managing the National TB Elimination Programme (NTEP) for the entire country at the central level. 

CTD works under the Directorate General of Health Services, Ministry of Health and Family Welfare (MoHFW), Government of India, and is the technical arm of the MoHFW. 

Figure: Relationship of CTD in the MoHFW