Using a Community Accountability Framework (CAF) for TB stigma reduction

Introduction and Rationale

Stigma and discrimination associated with TB are recognized as the most critical human rights-related barriers hindering the fight against TB. The most common cause of TB stigma is the perceived risk of transmission from TB-infected individuals to susceptible community members. This has an adverse impact on the health and health-seeking behaviour of people with TB. The social impact of stigma associated with TB on vulnerable populations like women, tribals, etc. prevents them from accessing healthcare in a timely manner, prolonging their ill-health further, and leading to adverse consequences on their overall health. The NTEP, in collaboration with REACH’s USAID-supported Accountability Leadership by Local communities for Inclusive, Enabling Services (ALLIES) Project is working to reach the last mile towards realizing the goal of TB elimination.

Objectives

Testing a Community Accountability Framework (CAF) to improve the quality of TB care and services. 

Overall approach and Key strategies

Through the implementation of the CAF initiative in Chhattisgarh, TB Champions fill a Quality Assessment Tool (QAT) every month through which they are able to identify gaps, including stigma. Through a consultative process with the state team, the TB Champions prioritize gaps and begin to ideate and generate resources to address the identified gaps. This work is being done under the guidance of the state NTEP to improve the quality of TB care and services.

TB Champions meet NTEP staff every month to get a list of persons with TB (PwTB) who have been registered for treatment. Once the TB Champions get the list of PwTBs, they contact them to get their consent and availability for field data collection.

Once an agreeable time has been fixed, the TB Champions meet the PwTB and fill up a hard copy of the QAT. The document is then checked and data is entered into the KoboCollect mobile application. The data is then analyzed by the ALLIES district strategists. This is followed by a meeting with the TB Champions to discuss the emerging gaps, which are then prioritized and addressed.

TB Champions have also been trained on rights-based approaches to TB and health to enable them to recognize stigma and discrimination when they interact with PwTB. They reveal their status as a TB survivor during these interactors. These conversations encourage and convince PwTB to speak about themselves.

As part of their work, the TB Champions provide psychosocial support to PwTB, and counselling services to the family members. PwTB who face stigma are counselled and followed up until the fear and discrimination that they face are allayed.

TB Champions also conduct awareness sessions in the community where the PwTB face stigma and discrimination. About 379 TB awareness sessions have been conducted in the past year, covering 5,772 people in the three districts.

The state-level TB Survivor-led network TB Mukt Chhattisgarh Foundation (TBMCGF) has also been actively involved in these initiatives. Recently, the officebearers of the TBMCGF, along with NTEP staff, were part of a TB awareness drive. Using mics fitted on bikes, TB Champions travelled about 20 km covering eight Gram Panchayats, and spreading messages on TB symptoms, diagnosis, and treatment. 

PRI members sensitized on TB have also contributed to TB awareness for stigma reduction. They have utilized public gatherings for TB awareness and IEC distribution. The sensitization of the school children on TB have resulted in creation of community volunteers who discuss TB in their families and identify those with TB symptoms. They inform Mitanins or Auxiliary Nurse Midwifes (ANMs) about family members with symptoms of TB. Spreading awareness among school children about TB promotes reduction in TB-associated stigma in the community. 

Implementation

The ALLIES project is currently being implemented across three districts, namely Raipur, Durg, and Balod in Chhattisgarh, covering a population of approximately 48.26 lakh.

Outcomes

About 9,358 PwTB were registered on the Ni-kshay Portal in three districts in one year. TB Champions covered approximately 3,841 PwTBs which is about 41% of the total PwTBs covered.

Key recommendations

From the experience so far, we can say that the CAF has the potential to reach the last mile towards TB Elimination, because it attempts not only to identify gaps but also to address them.

Potential for replication and scale-up

The National Strategic Plan (NSP) in TB elimination (2017–25) recommends identifying and training more TB survivors to TB Champions. TB survivors are first trained using the ‘From TB Survivor to TB Champion’ curriculum, followed by the training on CAF, which further enhances their skills to work towards improving the quality of TB care and services. The CAF initiative can be replicated among all TB Champions of other districts in Chhattisgarh.

Source : TBC India