Approaching TB Elimination through Community Engagement

Introduction and rationale

Community engagement is a process of developing relationships that enable stakeholders to work together to address health-related issues and promote wellbeing to achieve positive health impacts and outcomes. Community engagement aids in strengthening the trust between the community and national programmes by providing a platform for the community to have their voices heard, and their views considered and acknowledged. Community engagement also helps in enhancing the accountability of health services and improving the quality of care. It plays a critical role in the mission to end TB by supporting early case identification, treatment completion, and scale-up of TB preventive interventions, while reducing/preventing stigma and discrimination associated with TB, and addressing the social determinants of TB.

Objectives

The objective of community engagement activities is to empower persons with TB and caregivers among the vulnerable population and to create an enabling and non-stigmatizing environment that can support their treatment journey.

Overall approach and Key strategies

The state has adopted the strategies of engaging TB champions, Self-Help Groups (SHG), and NGOs working in the respective geographical areas by training them on TB. They engage in activities providing person-centric care, social and vocational support, and gender-sensitive approaches to TB. Under the Government of Karnataka’s Graama Panchayath Arogya Amrutha Abhiyaana (GPAAA) and through the Breaking the Barriers project of KHPT and USAID, the state is implementing community-based approaches across five districts of Karnataka.

Implementation

Formal SHGs in districts have been enlisted and sensitized through the TB programme, and they are actively involved in symptom screening and referral activities. Similarly, under the Breaking the Barriers project they have created a pool of individuals called community structures, which include SHGs, youth groups, informal groups, unions etc.

TB Champions are capacitated and sensitized on TB and their perspective on TB is built. They are equipped with communication and advocacy skills, and mentored to carry out these activities. Increased involvement of TB Champions in in-person care and support and advocacy initiatives, working with Care Support Groups, community structures, and health officials at different levels to support. This leads to the creation of an enabling environment at the community level. The Champions facilitate interactions with key stakeholders such as the healthcare providers and NTEP staff, using community friendly tools for advocacy at the local level.

Care and Support Groups (CSG) or PwTB-provider meetings also serve as a platform for TB and their caregivers to support and motivate one another to complete their treatment by sharing their experiences regarding treatment, consumption of nutritious food, and other concerns like stigma and discrimination. Persons with TB may also be provided nutrition support and linked to social welfare schemes for which they are eligible, such as the Ni-kshay Poshan Yojana. The CSGs help staff identify persons with TB (PwTB), and caregivers as TB Champions actively play a role in addressing systemic issues by providing feedback to local stakeholders on the quality and availability of drugs and services, and whether or not they meet person-specific needs.

The Kshaya Muktha Karnataka (TB free Gram Panchayat) programme has conducted IEC activities, verbal screening for TB in the villages, and linked PwTB to other social welfare schemes.

All these community engagement models actively engage with issues of those diagnosed with TB, link them to available services through frontline workers and state-mandated structures, and address gender barriers and stigma to create an enabling environment among communities for PwTB.

Outcomes

• About 657 TB champions have been identified, 377 trained and 473 engaged in various community engagement activities. About 200-250 SHGs have been trained in the districts of Mandya and Gadag and have actively involved in TB screening and referral activities, as well as awareness generation activities.
• A minimum of two person-provider meetings are held every month in each taluk at every district.
• Gram Panchayats have started linking PwTB to various social welfare programs, including nutrition support, employment, or livelihood under the Kshaya Asare program.
• TB sollisi GP gellisi, (TB Haarega Desh Jeetega) is in campaign mode, through which all GPs have planned various IEC activities like street plays, essays and quiz competitions in school, colleges.
• Using the health management kit Gram Panchayats conducted 11,116 non-communicable disease screening camps and screened 4,92,951 persons;12,50,816 individuals were screened under the Kshaya Nirvana program for TB and referred for testing. 

Key recommendations

All these community engagement activities will lead to the active participation of the community and make them take the responsibility of TB elimination into their own hands.

Conclusion

Community engagement activities will in turn lead to a people’s movement or Jan Andolan in real terms. Such activities will improve the coverage of specific vulnerable populations, such as urban vulnerable groups, tribal communities, migrants, and mining/industrial workers, and will contribute to increased case notification, and improved successful treatment outcomes in drug-sensitive TB and drug-resistant TB.

Source : TBC India