TB related Behaviour Change Solutions

Introduction

The government of India aims to eliminate TB by 2025. In order to identify and treat persons with TB, including those who are not diagnosed, there is a need for diverse approaches. Vulnerable populations like urban vulnerable, mining, migrants, tribal, industrial, and tea garden workers have a higher risk of developing TB compared to others due to occupational hazards, geographical limitations, socioeconomic inequalities, stigma, and gender discrimination. 

In order to ensure they are reached out to a behavioural change intervention guided by behavioural economics approach that has considered the unique sociocultural contexts of individual vulnerable groups was piloted in the three districts of Baksa, Dibrugrah and Kamrup (M). Implementation of these innovative behavioural change solutions (BCS) has resulted in faster TB notification and better treatment adherence among vulnerable populations.

Objectives :

• Develop and scale up effective behaviour change operational models that improve coverage of vulnerable populations (4,88,488) across the 9 TUs.
• Increased case notification, and improved successful treatment outcomes in DS TB and DR TB.

Approach

• Existing Community Structures (SHGs, VHSNCs, VDP, Unions, Mothers/Youth Clubs, other local associations, etc.) from the vulnerable communities were identified, trained and engaged in TB response activities.
• The selected community structure leaders undergo capacity-building training on the basics of TB, followed by regular handholding and guidance on organizing local activities that can influence health-seeking behaviours among the larger community.
• Active involvement of community structures in leading these local activities in support of TB Elimination, demonstrates high ownership and stake of the communities.

Key Activities

• Promote positive messaging & awareness (IEC) around TB in communities.
• Refer TB symptomatic for testing.
• Support in DSTB & DRTB notification.
• Mobilise support for PwTB & families (nutrition, counselling, social schemes), while facilitating treatment adherence.
• Increase demand for services areas.

Outcomes

• Behaviour change solutions are supporting faster TB notification and better treatment adherence among the vulnerable.
• Greater ownership from communities due to the ease of usage of the solutions.
• District & State NTEP find these very promising.

Key Recommendations

• Scientific approaches like behavioural economics can be leveraged successfully to address the needs of communities.
• Use of such approaches can help policymakers and health care service providers to better understand the needs of the vulnerable communities and design policies accordingly.
• Several of the BCS may be piloted as Best Practices in wider geographies.

Potential for Replication & Scale up

• BCSs offer scientific tools to trigger health-seeking behaviour among the vulnerable populace.
• These offer a range of innovative solutions with most requiring bare minimum additional cost or costs which may be borne from existing state/district budgets.
• Leveraging on the existing capacities of the Community Structures offers sustainability and high ownership by the communities
• Greater “Demand” generation and higher participation of the communities in the “Care & Cure” continuum.
• Ease of implementation in alignment with the CTD Guidance Document.

Source : TBC India