Directed Initiatives for Sustainable Health Action- (Disha-TB) in Telangana

Background (Problem Statement)
RNTCP (Programme Description)
Scalability
Financial Implications

Background (Problem Statement)

National TB Control Programme (NTCP) is being implemented since 1962. However, the treatment success rate is low and death & default rate remains high. Spread of MDR TB is threatening to further worsen the situation. India contributes 27% of the global burden of TB cases.

RNTCP (Programme Description)

Multi sectoral strategy is being adopted in Telangana to fulfill the commitment of eliminating TB by 2025. The key to strategy is immediate diagnosis and aggressive follow up of the treatment and awareness about the disease.

The community based approach followed in Telangana State is using the services of TB cured patients called “TB Champions” as Community Resource Person (CRP), to sensitize their community on TB. These TB champions were trained using a community training module.

The target oriented monitoring and evaluation was taken up regularly on the following:

Regular and aggressive review from state to sub center, with clear cut targets and achievements.
Ensuring prompt diagnosis of suspected cases and UDST coverage.
All PHCs started functioning as DMCs.
Refresher training for staff as per their job chart.
Policy of carrot and stick was adopted.
All school children were addressed on identifying symptoms of TB.

Phase-I plan under community based management is as under

Districts Covered	No.of Participants attended training	No.of training days	No.of teams allocated per district	Number of villages assigned per team	Number of villages target to cover	No.of Villages covered
10	250	50	5	20	1000	410

Overview of State Level Training - Community Based Approach

In the phase 1 of community based approach	Each core team comprises of 5 members	Target
50 teams were identified across 10 districts	2 - TB champions (cured TB patients) from local community	A total 1000 villages to be covered
Trained at the state level in a standardized phased manner	2 - ASHA and	50 Teams (@20 villages/team/district)
A total of 4000 Training Man Hours was used to train the teams	1 Health Supervisor

Timetable of 5 days state level training for CRP team members

Day 1	Day 2	Day 3	Day 4	Day 5
Brief on RNTCP What is a Community? Understanding common disease TB, causes, symptoms High risk groups for TB	Diagnosis of TB, Sputum collection Duration of TB treatment & adverse effects	Nutrition requirement for TB patients Success stories by TB Champions Role Play Group work	Incentives to TB patients (DBT) Patient support under other schemes Field visit (in community)	Community Support Role & responsibilities for each team members Action plan for village visit

Agenda for Field Teams during village wise visit

3 Days wise work plan in the Field
Day 1	Day 2	Day 3
Village Survey by the team Introduction of Training Team to the villagers School visit and sensitization of the school children and teachers Visit to old age group, Orphanage or any high risk setting in the village if any. Discussion on the line list of TB patients in the respective villages, defaulters, deaths, success case studies Gram Sabha Meeting DISHA-TB activity Singing, Skit Success stories	Gathering at community center/ Anganwadi Center Discussion with the patients and family members and their sensitization Sensitization of different Leaders in the village and planning for awareness activities with IEC. TB Clubs meeting in the presence of all Community leaders, staff and TB champions. Discussion on activities to be conducted in the village. Field visit by ASHAS/ANMS along with Supervision to collect samples from presumptive cases Screening of all symptomatic in the nearest DMC.	Documentation of activities conducted in last 2 days Home visit done by the team members to the patients on treatment, defaulted for counselling Recording and Reporting completion Group work and Action Plan for Way Forward

Scalability

Phase-I (Short Term)-10 districts
Phase-II (Mid-Term)-10 districts
Phase-III (Long Term)- PAN Telangana

Financial Implications

Incentive and Honorarium = 200 teams * 5 members* 25 days* 300rs/Day = 75 lakhs* 4 months = 3crore.
Training = 15 days at district level (200 teams*5 members *15 days @Rs500/ day = 75 lakhs

Source : We Care Coffee Table Book - Good, Replicable and Innovative Practices 2019

Last Modified : 6/12/2021

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