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.

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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).

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

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:    

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. 5 Guidelines and Norms for STDCs in NTEP 2023

Infrastructure for IRLs

The IRLs established should have the following infrastructure:

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

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.

Monitoring, review, supportive supervision and evaluation are important to ensure that the program is implemented as planned against the stated objectives and desired results. These are intensive technical activities and core function of the STDCs.

The STDCs need to lead activities in this area and support STCs. Designated nodal personnel (Medical officers, Epidemiologist, Statistician, Ni-kshay Operator) should be made accountable for regularly accessing data available from Ni-kshay and other program information sources. They should also be involved in analyzing the data and preparing analyses and program performance updates and reports for presentations (PPT) during review meetings. Based on the ongoing monitoring, review and supervisory activities, STDCs should regularly provide action-based feedback to districts and seek timely action taken report from them. 

Details of the processes and approach to be followed in monitoring, supervision and evaluation are available in the NTEP Supervision and Monitoring Strategy (Click here).

The role of STDCs in SM&E are described below.

Programme Monitoring

Programme monitoring means collecting, compiling and analyzing data to determine progress of various activities under the defined thematic areas against the stated objectives at the district and sub-district level on real-time basis and periodically. Monitoring uses a set of core indicators and targets to provide timely and accurate information in order to review performance and inform progress and thus facilitating decision-making processes. This helps us to find timely solutions to the performance gaps- in each district. Programme monitoring is also of paramount importance for ongoing programme planning and implementation. Programme monitoring should be a routine function of STDCs.

The STDC need to access the Ni-kshay data and monitor the completeness, correctness and timeliness of data entry. They have to monitor the district wise performances on a day to day basis using the key indicators suggested by the NTEP. Further periodic Ni-kshay data analysis has to be undertaken for monitoring program performance.   

Whenever there is a significant under/over achievement or a remarkable variation of a particular outcome indicator, STDCs need to do a 'Root Cause Analysis' by looking at the input, process and output indicators related to it to find out the reason for the same. Using the Ni-kshay data, STDCs also should do the person, place and time analysis to gain insights to identify patterns and anomalies that may indicate reasons for poor or under achievement.

Based on the ongoing review, the STDC needs to

1. Prepare and communicate the feedback with action points to the districts, as and when they find an issue in consultation with STO. The feedback shall include the detailed observations on key indicators, their Root Cause Analysis in short and suggested solutions to overcome the same.
2. Obtain timely action taken reports and in-turn monitor the change in performance after the action.
3. Purposively select Districts/ TB units (TUs)/ health facilities to be visited during supportive supervision, and evaluation.
4. Identify priority performance themes and geographies (Districts/ TUs) to be reviewed during periodic review meetings.

Programme Reviews

Review meetings are conducted periodically aiming at identifying areas and actions for improving the programme performance. They are essential for quality improvement and sharing of best practices. STDCs need to support STC in the planning and conduct of monthly review meetings of the districts state in the following ways.

Planning and preparation for reviews is a crucial step that STDCs need to undertake in consultation with STCs. Thorough preparation and advance planning of agenda items (Programmatic themes and operational areas) needs to be done prior to the meeting based on inputs obtained from ongoing monitoring.  

During the review meetings, STDCs should guide the discussions. such that they are based on objective criteria, and discussions progress in a consultative mode towards solutions. STDCs should  ensure that the discussions are not limited only to outcomes, but also to inputs, processes and outputs. STDCs also should ensure that districts share their experiences, challenges, and best practices to facilitate cross-learning platform.

STDCs need to ensure that the review concludes with action-oriented feedback directed at specific responsible persons. All the feedback should be communicated to the responsible authorities within one week of the review meeting. All the emerging feedback from the review meeting should be consolidated as minutes meeting. STDCs also need to track the actions taken by all concerned based on the decisions made in the meeting/ feedback provided. 

Supportive Supervision

Supervision is a systematic process for increasing efficiency of the health personnel by updating their knowledge, perfecting their skills, improving their attitudes towards their work and increasing their motivation. It is thus an extension of training.

Supervisory visits by STDCs should be a collaborative effort to identify problems and find solutions. The effort by the supervisory team, should be issue based and directed at provide ongoing support for solving problems and to overcome difficulties. Feedback provided during the visit should be constructive (with practical solutions) and not mere observations on performance. It should aim to build capacity of the health staff to implement the programme procedures correctly with high level of efficiency, to assess HR and training needs and to ensure data and service quality. At the end of the visit, the staff should be motivated and encouraged to effect solutions and bring improvements in programme performance.

Selection of districts: STDCs should conduct district wise supportive supervisory visits oriented towards the performance of the district as a whole, and in-turn evaluate performance and build the capacity/ competencies of the DTO and other NTEP staff and health functionaries. Selection of the district for supervision should be made based on the routine monitoring done by STDCs. Districts which require support need to be given preferences and shall be visited more frequently. However, selection should be done such that visits should cover all districts in the state at least once in a year.

Supervisory Team: A minimum of two members consisting of at least one medical officer from STDC/ RTPMC should visit the district for supportive supervision. And may be accompanied by STDC Director/ head of institution/ Senior Supervisory Staff from the state.

I. Conducting the visit in the district:

Key thrust programme operation areas for a supervisory visit should be purposively decided prior to the visit based on ongoing monitoring of the district performance. The institutions and corresponding staff to be visited may be decided based on the same. For example, if the reason for selection of a district is low treatment success rate from private sector, then high load private sector health facilities, current beneficiaries, their linked TU staff, and district PPM co-ordinator would be visited.

During the supervisory visit, data quality assessment in the selected focus areas should be done to assess correctness, completeness and timeliness. This would include verifying/ comparing data recorded in Ni-kshay (dates, categories, quantities) against the true/ actual value identified based on the context (recall/ records from beneficiary, hospital records etc.)   

II. Visit Planning:

The Medical Officer (SM&E) of the STDC/ RTPMC should prepare in advance the monthly supervisory visit plan along with the focus areas for each district and include the same in Advanced Tour Program (ATP). A minimum of two districts should be visited by the STDC supervisory staff every month. For better efficiency, supportive supervisory visits could be clubbed with EQA visits by IRL. The monthly visit plan (ATP) should be submitted to the STDC Director before 25th day of the previous month. The STDC Director in-turn should communicate it to STO, the corresponding districts and the linked National Institute before the first official day of the month.

The supervisory visit should be made for at least for 3 days or more working days in each district. Based on the selected thrust area, institutions, staff and beneficiaries to be visited, the Medical Officer (SM&E) of the STDC may consult district to chalk out a suitable travel plan in advance. Based on the plan the Medical Officer (SM&E) needs to arrange suitable travel logistics with the approval of the STDC Director.

III. Output of a Supervisory visit:

At the end of the supervisory visit, feedback should be prepared and it should be specific action oriented along with supporting observations, with timelines. The observations and recommendations of supervisory visit should be discussed with the DTO and team and also for any administrative issues the districts/ State Health authorities may also be appraised. It should be submitted to the relevant authority(District TB officer, CMO, STO etc) who should take the action within 7 days of the end of the visit. STDCs should ensure that the each recommendation is an activity/task for the district/state to perform. STDCs should advocate to solve any issues requiring actions at the state level. STDCs should also monitor the actions taken against each feedback and close the feedback once the task is satisfactorily accomplished.  

Internal Evaluation

Internal Evaluation forms an integral component of NTEP supervision and monitoring strategy. It acts as a tool to evaluate if good programme practices are adopted and quality services are provided to the community. These evaluations also offer an opportunity to look into all aspects of programme critically and swiftly. These activities help program managers in understanding determinants of good as well as poor performance for replication of good practices in other districts and take appropriate measures for their improvement.  

The STDCs should plan and lead the State Internal Evaluations. STDCs need to prepare a plan so as to cover all the districts in the state at least once in 3 years. Members of the team make plans and formats for evaluation should be based on the NTEP SM&E guidelines. 

One of the core responsibilities of STDCs is to ensure that the health system is trained in delivering TB services and managing the programme effectively. In order to ensure adequate skill set for delivering high quality TB care on a continual basis, the staff may require to be trained in-depth at the time of induction into the system and provided with updates as and when necessary. A proportion of them may also need to be re-trained either periodically or based on their performance gaps/ competencies. 

The STDC needs to directly execute training activities at the state level and also coordinate the execution of all the trainings of staff and trainers at the level of district and below. They may deliver training for the following purposes as mentioned below.

• Induction training: All the freshly recruited staff in the health system and deputed/ transferred into NTEP will require induction training in NTEP. Different categories of NTEP and General Health System staff have to be trained as per the relevant course curriculum (Modules/ hands-on training/ other guidelines) prescribed by NTEP for the respective cadre. 
• Update training: This training should be provided as and when there is a change in programme guidelines or new operational processes are being introduced. For this purpose it is preferrable that all such newer initiatives may be compiled as fresh modules for the respective cadre and later integrated into the existing course at national level when they are revised.
• Refresher training:  It is offered to the already trained officials either on their request or the official was trained long back and the supervisor or the official feels the need of training. Duration of this training will be similar to induction training or may be of shorter duration as per the need. Those who were already trained but were outside the programme for a significant period of time may also need to get a refresher training. (Periodically once in 3 years)
• Re-training: It is similar to Induction training for all the officials when a large sweeping change are adopted in the programme and the entire operational aspect is thoroughly changed or if an official needs to be retrained as per the assessment of the supervisor/ supervisory team.

The STDCs are required to train the trainers for all cadres in NTEP and facilitate and monitor cascade training for other staff at all levels of the health system in the state. 

At the beginning of the RNTCP era, ZN microscopy was the only diagnostic technology available and STDCs were made in charge of monitoring and ensuring quality. Since then, laboratory services in the NTEP has been under continuous evolution and expansion. The programme has expanded to use a range of technology to detect both Mycobacterium Tuberculosis as well as resistance to the various anti-TB drugs. These include LED microscopy, polymerase chain reaction (PCR) based rapid molecular tests/ NAAT and C&DST. These tests have been increasingly scaled up and integrated into the TB Programme. 

This evolution and expansion have resulted in laboratory services being a highly specialized Microbiological area. The IRL has evolved under the STDC as important institution in the NTEP. The IRL has the responsibility to ensure laboratory services for all technologies in the region are performing at the optimum standard and quality. In this context the STDC being the overarching institution for technical assistance to the state, it has to manage the IRL and ensure that it performs as per the expectations of the program. This includes:

1. Completion of Microscopy/ NAAT Quality Assurance activities in the region as per plan. The Framework for implementing microscopy EQA available here. 
2. Facilitating the certification process and quality assurance of all linked C&DST Labs in the state.
3. Co-ordinating the establishment of new C&DST labs in the state as per the needs, in consultation with CTD.
4. Facilitating ongoing Lab Trainings at STDC
5. Facilitating other ongoing programme functions in relation to laboratory services, mentioned in the corresponding sections.

Apart from the core routine activities of Training and SM&E, STDCs need to support the state by technically guiding the state TB programme. 

1. Support and preparing the state strategy plan for TB Elimination: STDCs need to plan strategies and support the state to adopt state specific strategies and programme implementation approaches taking into consideration the TB epidemiology and health system strength.

2. Implementation of new interventions: Based on evolving programme guidelines issued by the CTD, STDCs need to support the state in implementation of new interventions in the state. 

3. Support in preparing the PIP: The STDC based on the existing performance of the state and the needs identified based on the TB Elimination strategy of the state, needs to support the state and districts to prepare the PIP in such a way that the state and district NTEP is adequately resourced. 

4. Advocacy: The STDC needs to advocate and obtain resources required for the state level strategy. Advocacy may be directed towards the sources such as the NHM, State Health System, Government representatives and Panchayati Raj Institutions, private and corporate entities, and even to the civil society and community at large.

5. TB Surveillance: The STDC should have a clear understanding of the status of the TB burden and epidemiology of the state through continuous ongoing surveillance activities. This may include activities such as conducting surveys, analysis of programme data and additionally collect data as per need. Based on this activity the state may apply for Sub-National Disease free certification.

6. Generate evidence for programme interventions in alignment with state strategy through suitable Operational Research, and by evaluating, documenting and disseminating the best practices by publishing related reports and periodicals.  

7. Support Sub-national certification (SNC) for TB Elimination: STDCs need to support the SNC process.

Activities related to these processes need to be planned by the STDCs each year and budgeted in the PIP.  Further details of each technical activity is provided below.

There are three levels in EQA Laboratory network under NTEP

1. National Reference Laboratories (NRLs), which are the Central Institutes designated under NTEP. They monitor EQA activities of STDCs/ State labs for the programme. There are six NRLs, viz., National Tuberculosis Institute (NTI) Bengaluru, National Institute for Research in Tuberculosis (NIRT) Chennai, National Institute for Tuberculosis and Respiratory Diseases (NITRD), Bhopal Memorial Hospital and Research Centre (BMHRC) Bhopal, Regional Medical Research Centre (RMRC) Bhubaneshwar and National JALMA Institute for Leprosy and other Mycobacterial Diseases, Agra. Each NRL will eventually monitor 8-12 STDCs/IRLs.
2. STDC Laboratories will work as IRLs in the network. All States should have a State-level reference laboratory for EQA.
3. The Microscopy Centres (MCs)/NAAT sites working for NTEP in the districts will be the Peripheral laboratories.

The three main activities under the NTEP EQA protocol are;

1. On Site Evaluation (OSE): This evaluation is an important activity intended to evaluate whether the programme activities are being carried out i accordance with the recommended guidelines. Guidance is also provided for immediate corrective actions, wherever found necessary. OSE of the STDCs is done at least once a year by NRLs. DTCs (STLS) are evaluated once a year by STDCs and all MCs in the districts at least once a month by respective STLS. Importance will be given for taking action immediately at each level.
2. Panel testing (PT): Panel testing is done mainly to check the staining and smear reading proficiency of LTs of STDCs and STLS of TUs. The Panel testing is not used as a routine for LTs working at TB Diagnostic Centres (TDC). Panel testing of LTs of STDCs and STLS will be conducted once a year under the supervision of the visiting NRL/ STDC team. A set of pre-fixed unstained manufactured slides are used per technician under supervision of the visiting NRL/ STDC supervisor.
3. Blinded Rechecking of slides (RBRC): Blinded rechecking is the most important activity under the EQA programme. It determines the correctness of the smear results of LTs of MCs in an unbiased manner. It is not required for LTs of STDC as STDCs are expected to function at the supervisor level and are not required to perform patient related functions such as diagnosis and follow-up.

Methodology for all the three above mentioned activities is provided in detail in the revised NTEP EQA & DRS Protocols (refer to link)

The EQA for NAAT laboratories are undertaken annually by National Institute.

As an initiative to strengthen STDCs and enable them to perform their functions with better efficiency. The ECHO hubs have been established at STDCs. STDCs need to use these for improvement of programme efficiency and build the workforce capacity. Guidance for STDCs to design their virtual capacity building Programme and effectively utilise virtual knowledge hubs are as follows.

Virtual capacity building programs by STDCs

The knowledge hubs should be widely used by STDCs as a cross learning platform and for mentoring the health workforce at the periphery during the capacity building and programmatic reviews. Following are some of the ways it could be used.

1. Training and Capacity Building: STDC is responsible for ensuring that the entire health system workforce is completely trained in NTEP. The STDCs could use knowledge hubs for training and capacity building in the following ways.

   1. Regular training: STDCs lead the planning and implementation of regular and routine cadre-based training at all levels in the state for all healthcare staff working in the fight against TB in the state. This includes health system (Government or private), partners (NGOs, partner agencies etc) and other sectors. STDCs should effectively utilise Knowledge hubs for delivering the e- training courses for all cadres of including induction/ refresher/ update trainings. They need to prepare an annual training plan and decide which all courses could be scheduled as blended/ e- training through virtual platform. How such trainings could be conducted will be detailed in the training operations guidance under modernized training strategy under NTEP.

      NOTE: Training in only virtual modes should be used only in situations where physical training cannot be conducted.

   2. Thematic Trainings: STDCs shall organize thematic trainings as and when there is a new programme or when there is an update of the guideline/policy or based on the local needs, or as directed by CTD such as PMTPT, PMDT, SNC, Partnership Guidelines, new features in Nikshay. STDCs shall identify the need and decide which all courses could be scheduled as e- training through the virtual platform.
   3. Dissemination of ongoing programme Updates: STDCs could plan regular or need based academic sessions at a fixed frequency for a specific target audience. This could be planned and designed based on local need. All such sessions need to be didactic with active involvement from the spoke institutions. For example, STDCs could plan a one-hour session for all TU level staff on every fourth Friday regarding TB and NTEP updates.
   4. Special advanced courses for building capacity of health workforce/managers/administrators: STDCs could design and implement special courses beyond the routine/ regular training based on felt need of the State, for improving the efficiencies of the health or non-health workforce as an ECHO program. For example, a course on soft skills or communication or leadership or management or operations research or financial management could be imparted to selected cadre of staff virtually.
   5. Continuing Medical Education: STDCs could plan CMEs on TB at fixed frequency for a specific target audience. STDCs could collaborate with State task force (STF) or professional associations for such programmes. For example, session for all post-graduates and interns of medical colleges in collaboration with STF or session for general practitioners in collaboration with professional associations on every second Tuesday. Topics for such sessions could be decided based on local needs.
   6. Case studies / Best Practices/ Cross learning Platforms: STDCs could also arrange a platform for facilitating experience sharing regarding success stories from field. Success stories could be any best practices or local solution to particular problems documented with some learning experiences. For examples DTOs can present about a case study about how they maintained case finding during COVID-19 pandemic period or how they engaged all sectors for TB or how they solved the issue of poor coverage of TB preventive therapy (TPT) among people living with human immunodeficiency virus (PLHIV). Such programmes could be conducted regularly on fixed days (eg. monthly every second Wednesday at 12:00pm).
2. Programmatic Reviews and Supportive supervision: Programmatic reviews directed towards identifying problems and their solutions are an excellent opportunity for mentoring and improving capacity of district level and sub- district level staff. Data available through Nikshay and all other sources may be analyzed as prior preparation for the review and focused problem/ case-based approach may be used. These reviews need to be led and moderated by the STDC under the leadership of the STC.
   1. Periodic Reviews: These include monthly, quarterly, half yearly and annual review for the districts and other sub-levels organized by the STDC in consultation with STC These reviews could be directed internally within the NTEP or could be in collaboration with other programs such as National AIDS Control Organization (NACO) for cross learning and problem-solving activities.
   2. Need-based Thematic reviews: STDCs should conduct thematic reviews on periodically or based local needs. Such reviews will be focusing on one particular theme of the programme and will aim at building capacity of staff at field and solve problems at the field. These include reviews on PMTPT, PMDT, DBT, UDST, Private sector engagement, Pediatric TB Notification, Partnerships for TB Elimination, Finance, ACSM, Contact Tracing and so on.
   3. Virtual Supportive Supervision: STDC may use the virtual interaction platforms to conduct the supportive supervision activities aiming at handholding and mentoring of the staff at periphery in a virtual/ remote fashion. This includes virtual facility visit, physical examination of documents/ registers etc. Note that Periodic visits and regular supervision cannot be entirely replaced by virtual supportive supervisions.
3. Additional need-based capacity building: In order to ensure that complex problems are solved timely, the ad-hoc meetings and reviews play an important role. It ensures timely actions for improving a specific indicator or improvement of programme of a particular district, institutions or staff.

Annual Planning of Virtual activities

Based on the above types of each of the above three types of activities the STDCs may plan an annual calendar of virtual events.