Multi-Sectoral Engagement through TB Person Support Groups

Introduction and Rationale

TB has been a major public health concern, however, the investment in terms of newer diagnostics and efforts to contain the spread of the disease through the detection of infectious pulmonary cases and treating them effectively has been the cornerstone of the WHO-recommended DOTS programme.

However, services were disrupted due to the COVID-19 pandemic resulting in a decline of about 20% in TB notification. It was a major challenge to identify the missing cases and restore continuity of treatment and support.

One of the published landmark report in Lancet titled ‘High-quality health systems in the Sustainable Development Goals era: time for a revolution’ reiterated that it is not the medicines and equipment that can make a desirable change in terms of suffering and deaths. The quality of care, health outcomes, people’s confidence in the system, system competence, and user experience are equally important aspects. The health system includes private health care providers to whom people prefer to go first because of the perception of better quality of care, less waiting time, and less wage loss. The State Health Society took the conscious decision in June 2020 to engage private health care providers through contracts with non-profit NGOs as a Person Provider Support Agency (PPSA). It was soon realized that it was not sufficient to manage the change without engaging the community at large scale, and specifically at local level.

Objectives

To restore the continuity of diagnosis and treatment which was disrupted due to the COVID-19 pandemic and above all, the confidence of people affected with TB in health system.

Approach and Key Strategies

A letter from Executive Director, State Health Society, Bihar, was sent to Collectors and Chief Medical Officers (Civil Surgeons) of all the 38 districts to carry out Active Case Finding (ACF) under the broader umbrella of the ‘TB Haarega, Desh Jeetega’ campaign among vulnerable population, with clear outlines of phase wise activities.

Implementation

• 38 Districts, 534 blocks.
• During the course of implementation of ACF campaign, the requirement for a platform where local officers, PRI representatives can discuss the needs of people affected with TB was realized.
• The CARE India team, which has been supporting health system strengthening in maternal and child health services, came forward to coordinate at district and block level.
• A communication to Medical Officers in Charge, Child Development Project Officers, District Education Officers, Block Education Officers, and Block Resource Persons was sent to constitute ‘PwTB Treatment Support Groups’ in each block of all 38 districts.
• Centre For Advocacy & Research (CFAR) was engaged to draft and publish the success stories of cured PwTB, local challenges, and services available from government for PwTB.

Outcomes

• 19,06,459 people were screened and 40791 with TB symptoms were tested for TB and 3209 PwTB were notified and put on treatment.
• In addition, the outstanding support from local level resulted in the involvement of people from diverse backgrounds to unite against TB during the worst of the COVID-19 pandemic.

• Around 1586 success stories of cured PwTB were published in both the print and electronic media to facilitate public awareness and address the social stigma associated with TB
• Extensive media coverage influenced the policymakers to decentralize the rapid molecular testing up to the block level, and 207 TrueNat machines are now available for TB testing.
• There was 34% improvement in TB notification from 80/Lakh in 2020 to 122/Lakh (annualized) from January to July 2022.

Key Recommendations

The experience from the multisectoral approach through PwTB Treatment Support groups may be utilized for community ownership, demand generation, and advocacy for uptake of TB Preventive Treatment.

Potential for Replication and Scale-Up

As the entire activity was carried out with resources already approved under National Health Mission with support from local stakeholders, this process may be replicated in other health programmes also.

Source : TBC India