Designing Robust Tuberculosis Treatment Networks in Rural India

  • Duygu Cihan

Student thesis: Master's Thesis


Tuberculosis (TB) is considered to be the second disease that causes death among people and the seventh most infectious disease in the world. According to World Health Organization (WHO) 1990 report, the ranking of TB in the world will remain the same until 2020. Having approximately 3 million prevalence and 2 million incidence rate, India has the highest TB burden in the world. Although the Revised National Tuberculosis Control Program (RNTCP) covers majority of the country with DOTS (Directly Observed Treatment, Short-course) expansion, it is inadequate to achieve Millennium Development Goals (MDG) that aim to stop the progress of TB and reverse the incidence while reducing the prevalence by 50% and mortality rates relative to 1990 levels by the year 2015. Even though DOTS cover most of the rural areas, there is still need for effective control programs in the region areas of India. This study examines the TB conditions in Keota, Bihar; and aims to design the most appropriate treatment model for the given regions is very significant. The treatment delivery models are designed as a combination of strategic and operational decisions in health care supply chain. Two different treatment delivery models are proposed. First model aims to minimize the total cost of service delivery while locating health centers in the region and assigns counselors for following up the patients in case of in-adherence. On the other hand, the second model aims to minimize total service cost in while assigning mobilized health workers to patient location in such a way to obtain the optimum route. These models are formulated as mixed integer programming and solved using data provided from Aahan, a local TB control program, in GAMS. Finally the results and comparison of the proposed model are presented at the end.
Date of Award2011
Original languageAmerican English
SupervisorScott Kennedy (Supervisor)


  • Tuberculosis -India
  • Diseases

Cite this