NIKSHAY Online tool for monitoring TB control programme

NIKSHAY has been launched by the Government of India with the intention of creating a tuberculosis free nation

To keep a track of the TB patients across the country, the Government of India has introduced a system called NIKSHAY. The word is combination of two Hindi words NI and KSHAY meaning eradication of tuberculosis. NIKSHAY (www.nikshay.gov.in) is a web enabled application, which facilitates monitoring of universal access to TB patients data by all concerned. The system has been developed jointly by the Central TB Division of the Ministry of Health and Family Welfare and National Informatics Centre (NIC) and it was launched by the Government of India in June 2012 with issue of required administrative directions from Central TB Division for use of NIKSHAY. A gazette notification was published by the Government of India mandating all private health establishments to inform the details of TB patients treated by them to NIKSHAY repository.

NIKSHAY has two broad objectives. One is to create database of all TB patients including Multi-Drug Resistant cases across the country and to use this database for monitoring and research purposes at all levels so that TB can be eradicated from India in an  effective manner.

Overview of NIKSHAY
The innovative IT application of NIKSHAY makes it possible for the grassroot level healthcare providers to track every TB patient. The most significant feature of NIKSHAY is that it promotes using IT by Tuberculosis Unit (TU) level. In this way, NIKSHAY also contributes to reduction of the digital divide. Video based training module has been developed in Hindi and English with message from Deputy Director General, CTD, emphasising the importance of NIKSHAY in eradication of TB from India.

NIKSHAY has been implemented at national, state, district and Tuberculosis Unit (TU) levels. Data entry in terms of registering the TB patient, pre-treatment and follow-up tests, treatment, HIV and contact tracing details is done at TU level. More than 3.5 lakh TB  patients have been registered since its launch in June 2012. Such TB patient database is being used at district, state and national level for monitoring purposes.

Since TB has been notified by the Ministry of Health & Family Welfare, Government of India, therefore it is mandatory for the private health establishments or Government health establishment not covered under Revised National TB Control Programme (RNTCP) to inform about TB patients. NIKSHAY registers all such health establishments and entry of TB patients.

Ministry of Health & Family Welfare funds the hiring of contractual manpower at various levels for effective implementation of RNTCP scheme and programmatic management of drug resistant TB (PMDT). NIKSHAY facilitates the maintenance of details of all such contractual manpower helping the Central TB Division (CTD) to monitor the resource utilisation in an effective manner.

NIKSHAY utilises SMS technology in an effective manner. Through SMS, it communicates with TB patients and grassroots level healthcare services providers as well as health and family welfare policy makers, health managers and health administrators at different tiers of the healthcare delivery system. Whenever a new patient is registered on NIKSHAY, an SMS is sent to the patient with registration ID and details of DOTS Operator along with advisory note to take the regular medicine. Daily SMS is sent to all monitoring authorities in CTD, to State TB Officers (STO), District TB Officers (DTO) giving the number of patients, Designated Microscopic Centre (DMC)/Peripheral Health Interface (PHI) registered, profiles of STOs, DTOs and TUs updated, entry of contractual manpower, Health Establishments registered and patients have been notified.

The emergence of resistance to drugs being used to treat tuberculosis (TB), and particularly multidrug-resistant TB (MDR-TB), has become a significant public health problem in a number of countries and an obstacle to effective TB control. NIKSHAY has also felt the importance of MDR-TB patients and a module has been developed for keeping the records of patients at Intermediate Reference Laboratory (IRL), who are referred for Culture and DST test. These patients could be from RNTCP or come as follow-up patients from DRTB Centres or directly sent for pre-treatment test.

Present status
NIKSHAY was launched on 4th June, 2012 at http://www.nikshay.gov.in. As of now more than 3.6 lakh TB patients have been registered. Details of 34,261 DMCs/PHIs, 2268 TBU, 629 DTO and 53 STO are available.

CTD has been facilitated with reports having details of all the patients at national level and concerned patients at state, district and TU level through query and reports system. Dashboard has been provided so that any TB patient of the country can be contacted from CTD. Information about TB patients, which was earlier in Treatment Cards at Tuberculosis unit level, has been digitised for faster  access and monitoring.

Impact
During the last five month of its operations, substantial improvement has been observed in RNTCP operations. Programme implementing authorities at all levels are now enabled to retrieve details of any TB patient and if necessary, contact them for monitoring their DOTS administration schedule. The TB patients are now being given advisories through SMS. This facility has helped in awareness generation as well as encouraging patients to comply with their DOTS Programme. Another benefit of NIKSHAY is correlation between TB & HIV, leading to outcome analysis of treatment, which may give new directions to TB treatment in the coming years.

Expectations
Through NIKSHAY, CTD in association with NIC, wish to develop an integrated application for all types of TB patients across the country. Use of mobile technology for fast data availability and effective monitoring is expected from NIKSHAY. Innovative ideas through the use of other technological options are also being explored so that TB can be monitored effectively for its eradication from India.

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