by Dr. Rehana Begum
According to the World Health Organization (WHO), 10 million people suffer from tuberculosis (TB) every year. Although it can be prevented and cured, 1.5 million people die each year, making tuberculosis the world’s leading killer of infectious diseases. India bears the largest load of tuberculosis in the world, affecting about 2.4 million. In addition, almost 40% of Indians have a latent TB infection.
Given the number of TB cases in the country, there is an urgent need to bring the problem to the forefront and place TB patients at the center, surrounded by a family and community support ecosystem. Because TB patients suffer from socioeconomic consequences such as stigma and job loss, they often hide their illness, making it difficult for both treatment and complete recovery.
The current approach to tuberculosis prevention, care and support in India is largely biomedical, and these elements often escape. While the National Tuberculosis Elimination Program (NTEP) offers specific benefits and nutrition schemes such as the Nikshay Poshan Yojana that greatly facilitate the treatment journey of the patient with tuberculosis, structural barriers to stigma, discrimination, misunderstanding, lack of psychosocial support and lack of patients. Facility-focused approaches make the journey of TB treatment arduous and difficult for most.
While there is sufficient emphasis on solutions for adherence to treatment, much remains to be done to prevent infection and transmission of tuberculosis. Prevention approaches are rooted in community participation and addressing structural barriers also requires ecosystem-level initiatives with a close interface with all those that make up the environment of communities vulnerable to tuberculosis and also the community of infected and affected individuals.
This is where the KHPT project focused on tuberculosis comes in, the “Breaking Barriers” project. It uses a socio-ecological approach that recognizes the structural and underlying barriers that exist within specific vulnerable population groups. This ongoing project (2020-2024) seeks to fill the innovative critical gap by testing and demonstrating a set of pilots designed to address specific health barriers in unique contexts for different vulnerable populations such as miners, migrants, the poor. urban and tribal. , tea garden workers, etc.
Historically, public health programs around the world have taught us an important lesson, that is, achieving goals, reducing health inequalities, reducing disease prevalence, and addressing gaps in prevention, diagnosis, and prevention. care and adherence to treatment remain unattainable if communities are left out of response mechanisms. . There are several ways in which tuberculosis elimination can benefit when it is considered a community agenda rather than an exclusive responsibility of a health program.
This can be updated quite easily, as there are many formal and informal community networks and influencers representing these vulnerable populations. They have the potential to be the voice of the communities they work with and can lead tuberculosis initiatives at the grassroots level.
Then, the whole town has to be involved. In diseases such as HIV and tuberculosis, people’s perception of the disease needs to change. KHPT was able to do this with HIV quite successfully and all stakeholders met. The same can be seen in the polio campaign. Various groups participated, from health departments across the country to Rotary clubs and ASHA workers. There is a need to work with front-line workers from all departments – this is the crucial need for tuberculosis elimination.
In addition, we should look at the involvement of Panchayati Raj institutions. We all know the power the sarpanx wields over the local community. The pradhan has the power to spread precise messages, counteract misconceptions and stigma, and ensure that TB care services are available to the last mile. Gram pradhans can use the village Health Sanitation and Nutrition Committees to raise tuberculosis-related issues at monthly meetings. Gram pradhans after being trained on tuberculosis and having been empowered enough to mark the challenges related to tuberculosis services when needed.
We also saw how people came together to fight the COVID-19 pandemic. If we want to accelerate progress towards the goal of tuberculosis elimination in the country, we must implement a society-wide approach to eliminating the disease by always putting the community-focused approach first.
Dr. Rehana Begum is the project director, Breaking Barriers, the KHPT Tuberculosis Removal Program.
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