Integration of TB Services at Ayushman-Bharat Health and Wellness Centres

Introduction and Rationale

In recent times, Government of India has taken several steps towards TB elimination which has led to remarkable progress in terms of improving the lives of millions of families affected by TB. One such high-priority step is the integration of TB program activities with a wider healthdelivery mechanism through a collaborative approach to ensure TB elimination. TB services are now being integrated at Ayushman Bharat Health & Wellness Centres (AB-HWCs) with the aim of improving reach of TB services at primary healthcare level. AB-HWCs are to play a huge role in improving the awareness about TB, early identification, ensuring treatment adherence, providing psychosocial support to PwTB and their families etc. Providing TB services at the doorstep also will help in saving the travel costs out-of-pocket expenditure.

Objective

The AB-HWCs at the grass root level are at the forefront of providing health care in India and engaging these centers for service delivery is vital for the effective implementation of all the health-related programs in the country.

Implementation

The integration of TB services at AB-HWCs was kickstarted by the State TB cell under the guidance of MD NHM and the Additional Chief Secretary (Health) with the support of Jhpiego, during the TB Mukt Bharat Campaign March 24- April 13, 2022. The activities planned for integration of TB services at HWCs were under three heads:

Strengthening of TB services delivery through Health and Wellness Centres –

• Integration of AB-HWCs with NTEP as Peripheral Health Services (PHIs) with creation of their Ni-kshay log-in credentials,
• Refresher training to Community Health Officers (CHOs) by NTEP team at district and subdistrict levels with handing over of Ni-kshay.
• Enrolment of the presumptive TB cases and linking them to aligned TB diagnostic centres. Community engagement in TB symptom screening, referrals of presumptive TB cases and their enrollment in the Ni-kshay portal.
• Notification of all newly-diagnosed cases under the catchment area of HWC, from the HWC login ID and transfer of old cases from the TU login ID to the HWC login ID for follow-up and treatment adherence monitoring.
• Household contact visits by the HWC team, providing counselling for airborne infection control, cough hygiene, treatment adherence, care of comorbidities, as well as the household contact tracing for TB symptoms and all other public health actions.
• Installation of self-learning app (Ni-kshay Setu) in the CHOs’ tab, and facilitating them to complete the course.
• Installation of TB Arogya Saathi app in the PwTB’s’ Android mobile phone.

Community Screening Camps and Awareness Sessions

• TB-free pledge at multiple public gatherings, including VHSNC, Mahila Arogya Samithi etc.
• Community engagement sessions at schools, Anganwadis, Self Help Groups, etc.
• TB awareness generation camps at the local Haats in the HWC catering areas.
• Community screening camps for TB and NCDs at HWCs/aligned health sub–centres.
• Person – provider meetings where the attendees were informed about the person’s rights, the roles and responsibilities of treatment supporters, etc.
• Identification of one TB Champion at the HWC level, and training of these TB champions by the CHO/Senior Treatment Supervisors/TB Health Visitors. 

Active Case Finding:

• Health Care Providers (both public and private)
• Household contacts of all the PwTB in the past five years
• All diabetic persons enrolled in the HWC and other vulnerable groups like People Living with HIV, alcoholics, the malnourished, pregnant women, organ transplants, tobacco users, etc.

Monitoring and Evaluation of the campaign

Six teams were built at the state level, including the State TB Cell, State TB Training and Demonstration Centre (STDC) staff, and partner representatives from organizations like WHO, Jhpiego, etc. Each team visited four districts each, thereby covering the 24 districts of the state. Daily data was captured from all the districts through an Excel tool developed with the support of Jhpiego. The districts made teams of Senior TB Supervisor/TB Health Visitor, Senior TB Laboratory Supervisors and one district level staff per block for the monitoring of the activities in the field.

Post Campaign Strategy

Jhpiego was assigned as the partner for strengthening the TB services at HWCs and its monitoring and reporting to the state. All the District TB Officers (DTOs) were trained at the state headquarters by the STDC and Jhpiego on integration of TB services at HWCs post the campaign. Jhpiego, during their supportive supervision visits to the districts, also evaluated the status at the districts, and sensitized the DTOs, Civil Surgeons and Deputy Commissioners of the districts on the need for providing TB services through HWCs.

Outcomes

In order to integrate AB-HWCs with NTEP and provide TB health services in the community, 1536 AB-HWCs have been registered to the Ni-kshay portal and provided their login credentials. The integration started from January 2022 onwards and HWCs have started enrolling and notifying PwTB. In last three quarters in 2022, ABHWCs have notified 2311 PwTB and providing them TB care and services. 

Key Recommendations

The AB-HWCs are going to be the future of grassroot-level healthcare in India and engaging these centres for service delivery is vital for effective implementation of all the health-related programs in the country. Engaging and capacity building of a large cadre of CHOs is one of the challenges faced.

Source : TBC India