Norms for establishing an STDC

Norms for establishing an STDC

Every State/Union Territory should have at least one functional STDC, established with infrastructure, equipment and human resource (HR, norms provided subsequently). It is preferably located alongside or nearby the State TB Cell (STC) at the State Headquarters/Capital, for administrative convenience, effective co-ordination and sharing of responsibilities.

In larger states, with a population of more than 5 Crore/more than 20 NTEP districts, they can establish additional STDCs or the single STDC at the state may be supported by additional Regional Training and Programme Monitoring Centre (RTPMC). The RTPMCs may be delegated with the responsibility of capacity building and SM&E activities. These additional centres would be governed by the single STDC at the state and may be resourced as per norms provided subsequently. RTPMCs function similar to STDCs, but they are placed away from the state headquarters based on the geographical and local considerations.

Integration with General Health System: Wherever there are no STDCs/RTPMCs as per the norms provided above, the state may decide to build the STDC/RTPMC in an appropriate existing state institution like the State Institute of Health and Family Welfare (SIHFWs) and regional training centres. Dedicated HRs, infrastructure and equipment as per NTEP norms may be provisioned to these institutions.

Heena.goyal

Human Resource

Human Resource

The STDC works under the leadership of the STDC Director/Head of the Institution (STDC). She/he is an appropriately senior official from the state health system, preferably a TB specialist, or specialist qualified in Community Medicine or Public health or Microbiologist, having prior TB programme management experience, e.g., a former District TB Officer (DTO). In exceptional situation, the STDC Director/Head of the Institution may be from other specialties as per state policy. The STDC Director needs to be trained at National Level at a National Institute. This position is a regular and full-time post and the minimum tenure for a STDC Director is recommended for a period of 5 years, to ensure effective leadership at the STDC as well as to provide technical and operational support to the state in an efficient implementation of NTEP activities.

The staffing structure of the STDC should be given as mentioned in Figure 1. These positions may be regular positions from the State Health System or may be contractual staff as decided by the state health administrators. Three technical sections of the STDC – Training, SM&E, and the Intermediate Reference Laboratory (IRL) will each be trained at the National Institute. The Medical Officer-Training Division should be TB specialist, or specialist qualified in Community Medicine or Public health; Medical Officer-SM&E should be a specialist qualified in Community Medicine or Public health; while the IRL will be led by a Microbiologist.

The Medical Officer-Training is responsible for planning, organizing and conducting NTEP Training in co-ordination with other NTEP programme managers and medical college faculty. They ensure the availability of trained manpower and the conduct of need-based trainings at the district and sub-district level. They are supported by the Training Co-ordinator and a Statistical assistant. Together, they assess the training needs, prepare and execute the training calendar for STDC and district trainings across the state, according to the latest NTEP Training Guidelines in co-ordination with the DTOs and other staff.

Figure 1: STDC Organogram

The Medical Officer-SM&E supported by an epidemiologist, biostatistician/statistician and Ni-kshay Operator, are responsible to conduct SM&E activities, at the state and district levels and ensure the optimum programme performance as elaborated in the NTEP-SM&E guidelines. 

The IRL-Microbiologist is supported by the IRL staff as depicted in Figure 1 below. The IRL serves as reference Centre for diagnostic services and facilitates the establishment of decentralized facilities for TB diagnosis and infection detection. In addition, they will conduct laboratory-based hands-on training and External Quality Assessment (EQA) and Quality Improvement of decentralized laboratories functioning at the district and lower levels.

For administrative and financial functions, the STDC Director will be supported by an Administrative Officer, Accountant, Secretarial Assistant and other supporting staff (UDC-LDC). The Accountant manages the funds received for conducting the STDC activities and the Secretarial Assistant supports the STDC Director in general administration under the supervision of the Administrative Officer.

The RTPMCs need to follow the same staffing structure as the STDC, all of whom may report to the nodal STDC Director of the state. The senior most of the two medical officers at the RTPMC be in-charge of day-today administration.

When RTPMCs are built inside any existing state institutions, such as the SIHFW/Regional training institutions, the state may decide the organogram/reporting protocol for the staff of the RTPMC for administrative purposes. However, it is crucial to ensure that technical reporting to the STDC Director is maintained.

The above structure is the minimum HR expected for any STDC. The STDCs of larger states may need to be provided with additional staff, based on the load of activities. The norms for the qualifications and experience required for each of the STDC staff is mentioned in the latest HR norms and Terms of Reference (TORs), published by the Central TB Division (CTD).

 

 

RakeshPS

Infrastructure and Equipment

Infrastructure and Equipment

The STDC may preferably be located in the same premises where State TB Cell (STC) is situated or in close proximity for better co-ordination.

Every STDC/RTPMC needs to have adequate infrastructure and equipment to conduct its necessary functions. These include office rooms, training/meeting rooms, laboratory facility and residential/hostel facilities.

Office Rooms and Related Equipment

The STDC office rooms include the chamber of the STDC-Director, rooms for section in-charges (Training), SM&E and Microbiology divisions/units. It should also include appropriate space for the Training and SM&E section. It is desirable that the establishment section is located adjacent to the Director/Head of the Institution room/Chamber. STDCs/RTPMCs should also be equipped with adequate number of computers/laptops for each staff of the STDC.

Training/Meeting Rooms

  • Auditorium with a seating capacity of approximately 50 people. It should be equipped with necessary audio-visual (AV) support.
  • A separate room with a capacity of approximately 40–50 people for conducting district review and other administrative meetings.
  • Three rooms with seating capacity of 15–20 people each. There needs to be separate class rooms wherever possible to have close interaction with each trainee during physical training.

Residential/Hostel Facilities

The number of residential facilities (approximately/at least 25 rooms) need to be provisioned based on the expected number of trainees undergoing concurrent training at the STDC. These may also be used for boarding and lodging of programme managers during review meetings. The hostel needs to have canteen, dining hall and housekeeping arrangements.

Modernized Training Unit    

The STDCs/RTPMCs should be provided with the necessary equipment to effectively deliver trainings as per the requirements of the Modernized Training Strategy of NTEP. The Units may be installed in the auditorium/two training/meeting rooms as described above. Modernized Training Units at STDCs require facilities, such as:    

  • High-speed internet connectivity (either through a >50 MBPs leased-line or through a >200 MBPs Broadband/Fibre connection);
  • Virtual meetings/knowledge dissemination setup (Virtual meeting service subscription, 3 Televisions, Camera, speakers, microphone);
  • Interactive Digital Board (>65-inch diagonal size), or LCD Projector and screen (minimum 3 sets) along with Laptop or computer;
  • Digital devices/tablets (minimum 40 sets) for the trainees;
  • Portable AV equipment such as speakers, wireless microphones, laser pointers for trainings at satellite sites (minimum 2 sets).

Transportation

The STDCs need to have vehicle support to effectively deliver SM&E activities as per the policies of the State and for field-visit demonstrations to the trainees. If no vehicles are available, it may be hired from a suitable outsourcing agency.

The above training, residential and equipment facilities ideally be dedicated for the STDCs/RTPMC, but may also be shared with or borrowed from any regional/State Institute (SIHFW) or medical colleges as appropriate. 

Infrastructure for IRLs

The IRLs established should have the following infrastructure:

  1. At least 2 rooms for sputum examination (Processing and Microscopy)
  2. Sample receipt room
  3. One room for sample opening with Biosafety Level-II facility
  4. TB containment laboratory
  5. Reagent and Media Preparation room
  6. Equipment area
  7. One washing and sterilization room
  8. Three physically separated rooms for conducting Line Probe Assay
  9. One room for Nucleic Acid Amplification Test activities
  10. One room for Laboratory Information Management System (LIMS), Ni-kshay Operator (DEO) and reporting
  11. Separate staff room with washroom for males and females
  12. One store room
  13. Walk in Cold room

The above infrastructure and related equipment and consumables need to follow Technical specifications provided by NTEP (Lab consumables, Equipment).

RakeshPS

STDC Administration

STDC Administration

The STDC as an institution will function under the supervision of the STC. It will manage the RTPMCs and IRLs/ C&DST in the state. The STDC will have three sections: (1) the Training Section, (2) SM&E Section and (3) the IRL Section; each of which have a dedicated stream of activities in relation to conducting NTEP training, SM&E and laboratory-related work in the state. The personnel in these three sections will collaborate to provide all required technical assistance to the STC, such as PIP preparation and Operation Research. 

The STDC will need to be empowered with adequate financial and administrative autonomy to conduct planned activities. The STDC will annually prepare an action plan prior to the State PIP process. The action plan has to include all training, SM&E, IRL and technical activities, such as operational research etc. The general norms for the quantum of each activity under each section should be based on needs/gap assessment keeping in mind the functions of STDC as detailed below. The action plan will also have to include the relevant budget with proper justification and timeline, and will have to be incorporated into the State PIP. Care has to be taken to ensure that the activities and budget include the necessary travel of STDC personnel within the state and other parts of the country for executing all its functions. The STDC staff may travel by hiring vehicles, through air/rail/ferry as appropriate, following the state National Health Mission (NHM) norms. However, the technical staff who are not entitled to travel by state norms, may be allowed to travel by air for attending National or Regional Level trainings/Workshops/Meetings/Evaluation visits, if it is an overnight journey or travel involving more than 500 km. They should be provided with timely permissions and TA/DA as per their entitlements/reimbursement of actual expenditure incurred with proper justification. 

Once the PIP is approved, the total annual budget approved for the STDC and its divisions may be transferred to the STDC, to be used for approved activities under the annual plan.

Heena.goyal